Healthcare Provider Details

I. General information

NPI: 1942210299
Provider Name (Legal Business Name): BASHAR OKKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7188 N MAIN ST
CLARKSTON MI
48346-1571
US

IV. Provider business mailing address

7188 N MAIN ST
CLARKSTON MI
48346-1571
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-1600
  • Fax: 248-625-0239
Mailing address:
  • Phone: 248-625-1600
  • Fax: 248-625-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301064241
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: