Healthcare Provider Details

I. General information

NPI: 1790798304
Provider Name (Legal Business Name): BASSAM J DAGHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COLUMBUS AVENUE 3175 COLUMBUS AVENUE
BAY CITY MI
48706
US

IV. Provider business mailing address

916 WASHINGTON AVENUE SUITE 323
BAY CITY MI
48708
US

V. Phone/Fax

Practice location:
  • Phone: 989-891-9050
  • Fax: 989-891-9070
Mailing address:
  • Phone: 989-891-9050
  • Fax: 898-891-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301071281
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: