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General NPI Number Information
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NPI Number | 1043283849
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Entity Type | Individual
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Provider Name | AHSAN M BASHA MD
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 1490 E WALNUT ST STE A
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City | WATSEKA
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State | IL
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Zip | 60970-1806
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Country | US
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Telephone | 815-432-0250
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Fax | 815-432-5217
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Provider Business Mailing Address
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Address Line | 1490 E WALNUT ST STE A
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City | WATSEKA
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State | IL
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Zip | 60970-1806
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Country | US
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Telephone | 815-432-0250
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Fax | 815-432-5217
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 30683
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 036093863
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License Number State | IL
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