MEDICARE: NASRULLAH M. BASHA, MD, LTD

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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1992720668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASRULLAH M. BASHA, MD, LTD

Provider Business Mailing Address
First Line	:	2315 E 93RD ST
Second Line	:	STE 222
City	:	CHICAGO
State	:	IL
Zip	:	60617-3936
Country	:	US
Telephone Number	:	773-734-4242
Fax Number	:	773-734-1448

Provider Business Practice Location Address
First Line	:	2315 E 93RD ST
Second Line	:	STE 222
City	:	CHICAGO
State	:	IL
Zip	:	60617-3936
Country	:	US
Telephone Number	:	773-734-4242
Fax Number	:	773-734-1448

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	NASRULLAH M BASHA
Credential	:	MD
Telephone Number	:	773-734-4242

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/22/2020

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