Basic Information
Provider Information
NPI: 1740327568
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BASI
FirstName: AMRIK
MiddleName: SINGH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 220 STANDIFORD AVE F
Address2:  
City: MODESTO
State: CA
PostalCode: 953501159
CountryCode: US
TelephoneNumber: 2095795628
FaxNumber: 2095795637
Practice Location
Address1: 1524 MCHENRY AVE 340
Address2:  
City: MODESTO
State: CA
PostalCode: 953504567
CountryCode: US
TelephoneNumber: 2098463176
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/31/2007
LastUpdateDate: 07/16/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QA0505XA92203CAY Allopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine

No ID Information.


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