MEDICARE: DR. BHUVANESWARA RAJU BASINA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1144496639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHUVANESWARA RAJU BASINA MD

Provider Business Mailing Address
First Line	:	2931 VAN AKEN BLVD
Second Line	:	APT#15
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2244
Country	:	US
Telephone Number	:	313-268-7073
Fax Number	:

Provider Business Practice Location Address
First Line	:	2931 VANAKEN BLVD
Second Line	:	APT # 15
City	:	CLEVELAND
State	:	OH
Zip	:	44120-4422
Country	:	US
Telephone Number	:	313-268-7073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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