Healthcare Provider Details

I. General information

NPI: 1780861807
Provider Name (Legal Business Name): QASIM BASHIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SOUTHERN BLVD STE 300
KETTERING OH
45429-1265
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-643-9299
  • Fax: 937-643-2343
Mailing address:
  • Phone: 937-762-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35087119
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number036-116646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: