Provider Demographics
NPI:1992720668
Name:NASRULLAH M. BASHA, MD, LTD
Entity type:Organization
Organization Name:NASRULLAH M. BASHA, MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NASRULLAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BASHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-734-4242
Mailing Address - Street 1:2315 E 93RD ST
Mailing Address - Street 2:STE 222
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3936
Mailing Address - Country:US
Mailing Address - Phone:773-734-4242
Mailing Address - Fax:773-734-1448
Practice Address - Street 1:2315 E 93RD ST
Practice Address - Street 2:STE 222
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3936
Practice Address - Country:US
Practice Address - Phone:773-734-4242
Practice Address - Fax:773-734-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL470340Medicare ID - Type UnspecifiedMEDICARE PROVIDER #