Provider Demographics
NPI:1467453696
Name:BASNIGHT, MICHAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:BASNIGHT
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 1:600 BIRD BAY DR W
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-8020
Mailing Address - Country:US
Mailing Address - Phone:941-782-0505
Mailing Address - Fax:833-753-3297
Practice Address - Street 1:600 BIRD BAY DR W
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-8020
Practice Address - Country:US
Practice Address - Phone:941-782-0505
Practice Address - Fax:833-753-3297
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61490207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651092361OtherTAX ID
FL17840XMedicare ID - Type Unspecified
FL17840OtherBCBS
FLF35383Medicare UPIN
FL060063609OtherMEDICARE RR
FL060063609OtherMEDICARE RR