Provider Demographics
NPI:1427105220
Name:BASHOUR, BASSAM N (MD)
Entity type:Individual
Prefix:
First Name:BASSAM
Middle Name:N
Last Name:BASHOUR
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:29200 SCHOOLCRAFT
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150
Mailing Address - Country:US
Mailing Address - Phone:734-523-1050
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:29200 SCHOOLCRAFT
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150
Practice Address - Country:US
Practice Address - Phone:734-523-1050
Practice Address - Fax:734-523-2464
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031346207RN0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB031346OtherCHAMPUS-CHAMPUS
BB031346OtherCOMMERCIAL-COMMERCIAL NUMBER
BB031346OtherCOMMERCIAL-COMMERCIAL NUMBER