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General NPI Number Information
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NPI Number | 1992720668
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Entity Type | Organization
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Legal Business Name | NASRULLAH M. BASHA, MD, LTD
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2315 E 93RD ST STE 222
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City | CHICAGO
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State | IL
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Zip | 60617-3936
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Country | US
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Telephone | 773-734-4242
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Fax | 773-734-1448
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Provider Business Mailing Address
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Address Line | 2315 E 93RD ST STE 222
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City | CHICAGO
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State | IL
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Zip | 60617-3936
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Country | US
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Telephone | 773-734-4242
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Fax | 773-734-1448
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | NASRULLAH M BASHA
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Credential | MD
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Telephone | 773-734-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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