Healthcare Provider Details

I. General information

NPI: 1376115105
Provider Name (Legal Business Name): BISMAH BASHARAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5453 HAMPTON PL
SAGINAW MI
48604-9284
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-907-7636
  • Fax:
Mailing address:
  • Phone: 844-832-1956
  • Fax: 216-778-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4351048214
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: