MEDICARE: DR. BASMAL G YALDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5315041050	MI
2	390200000X	Student in an Organized Health Care Education/Training Program	5315041050	MI

General Provider Information

NPI Number	:	1346479789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASMAL G YALDO MD

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR # J2000
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:	734-747-6766
Fax Number	:	734-222-3100

Provider Business Practice Location Address
First Line	:	4123 MARTIN RD STE 102
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-4151
Country	:	US
Telephone Number	:	248-366-3700
Fax Number	:	248-366-1038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	11/24/2025

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