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General NPI Number Information
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NPI Number | 1275835845
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Entity Type | Individual
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Provider Name | IMAD SHAMSI BASHA M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 1900 MERCY DR
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City | ORLANDO
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State | FL
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Zip | 32808-5612
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Country | US
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Telephone | 872-231-3162
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 734951
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City | CHICAGO
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State | IL
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Zip | 60673-4951
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Country | US
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Telephone | 702-899-0595
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Fax |
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME141888
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 35.065103
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 4301075324
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License Number State | MI
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