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NPI Code Detail

MEDICARE: DR. MUSTAFA M BASREE DO, MS

MEDICARE: DR. MUSTAFA M BASREE DO, MS
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
1390200000XStudent in an Organized Health Care Education/Training Program
22085R0001XRadiation Oncology Physician81340-21WI
3390200000XStudent in an Organized Health Care Education/Training ProgramWI

General Provider Information

NPI Number : 1710563689
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MUSTAFA M BASREE DO, MS
Provider Business Mailing Address
First Line : 749 UNIVERSITY ROW STE 200
Second Line :
City : MADISON
State : WI
Zip : 53705-1465
Country : US
Telephone Number : 608-890-8836
Fax Number : 608-262-0307
Provider Business Practice Location Address
First Line : 600 HIGHLAND AVE
Second Line :
City : MADISON
State : WI
Zip : 53792-1465
Country : US
Telephone Number : 608-890-8836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2021
Last Update Date : 07/16/2024

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