Provider Demographics
NPI:1427723675
Name:COMMUNITY CARE OF DOWAGIAC, PLLC
Entity type:Organization
Organization Name:COMMUNITY CARE OF DOWAGIAC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:269-462-9587
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-0364
Mailing Address - Country:US
Mailing Address - Phone:269-462-9587
Mailing Address - Fax:269-462-9589
Practice Address - Street 1:57392 M 51 S
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-9766
Practice Address - Country:US
Practice Address - Phone:269-462-9587
Practice Address - Fax:269-462-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI74575Medicaid
MI4837343Medicaid