Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 30683 | AZ |
Y | 207RX0202X | Medical Oncology | 036093863 | IL |
NPI | 1043283849 |
---|---|
Provider Name | Dr. Ahsan M Basha |
First Address | Watseka, IL 60970-1806 |
Second Address | Watseka, IL 60970-1806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036093863 | (05) | IL |
71173 | MEDICARE ID (01) | AZ |
71613601 | (05) | AZ |
G34412 | (02) | AZ |