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NPI Code Detail

MEDICARE: I BASILIO MD, PC

MEDICARE: I BASILIO MD, PC
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
12080A0000XPediatric Adolescent Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356477616
Entity Type Code : Organization
Provider Name (Legal Business Name) : I BASILIO MD, PC
Provider Business Mailing Address
First Line : 104 14TH ST
Second Line :
City : COLUMBUS
State : GA
Zip : 31901-2131
Country : US
Telephone Number : 706-507-5437
Fax Number :
Provider Business Practice Location Address
First Line : 2039 WARM SPRINGS RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-7931
Country : US
Telephone Number : 706-576-5570
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : FEODERIS N BASILIO
Credential : M.D.
Telephone Number : 706-507-5437
Provider Enumeration Date : 02/23/2007
Last Update Date : 10/31/2011

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