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General NPI Number Information
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NPI Number | 1124590757
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Entity Type | Organization
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Legal Business Name | NICOLE BASILE MD PA
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 1500 N DIXIE HWY STE 304
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2717
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Country | US
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Telephone | 561-475-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 N DIXIE HWY STE 304
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2717
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Country | US
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Telephone | 561-475-5700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE ANN BASILE
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Credential | MD
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Telephone | 561-475-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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