Healthcare Provider Details

I. General information

NPI: 1902804321
Provider Name (Legal Business Name): WILLIAM K BASEDOW D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S 7TH ST SUITE 1
IRONTON OH
45638-2542
US

IV. Provider business mailing address

2117 S 7TH ST
IRONTON OH
45638-2538
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-3100
  • Fax: 740-532-8558
Mailing address:
  • Phone: 740-532-3100
  • Fax: 740-532-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34005686
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: