MEDICARE: BASIT ALI D.O.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	M0340	TX
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	M0340	TX

General Provider Information

NPI Number	:	1962480632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASIT ALI D.O.

Provider Business Mailing Address
First Line	:	3500 W WHEATLAND RD
Second Line	:	GROUND FLR, POB #3
City	:	DALLAS
State	:	TX
Zip	:	75237-3460
Country	:	US
Telephone Number	:	214-947-0752
Fax Number	:	214-947-0751

Provider Business Practice Location Address
First Line	:	3500 W WHEATLAND RD
Second Line	:	GROUND FLR, POB #3
City	:	DALLAS
State	:	TX
Zip	:	75237-3460
Country	:	US
Telephone Number	:	214-947-0752
Fax Number	:	214-947-0751

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	09/02/2014

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Directions to “ BASIT ALI D.O.” Practice Location

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