Provider Demographics
NPI:1427071059
Name:BASHIR, JAVAID M (MD)
Entity type:Individual
Prefix:DR
First Name:JAVAID
Middle Name:M
Last Name:BASHIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3060
Mailing Address - Country:US
Mailing Address - Phone:517-392-1651
Mailing Address - Fax:734-484-0529
Practice Address - Street 1:1034 4TH ST
Practice Address - Street 2:MULTIPLE OFFICE LOCATIONS
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3060
Practice Address - Country:US
Practice Address - Phone:517-392-1651
Practice Address - Fax:734-484-0529
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047107207R00000X, 207Q00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4374715-10Medicaid
MI4374715-10Medicaid