Bastasch, Michael David
Bastasch, Michael David is an individual health care provider with primary practice located at 39101 Civic Center Dr , Fremont CA 94538-5817. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Bastasch, Michael David can be contacted via phone (510) 796-7212.Contact Information
Primary practice address
39101 Civic Center Dr
Fremont CA 94538-5817
Phone: (510) 796-7212
Fax: (510) 745-6469
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | A85084 | California |
| Other Service Providers / Specialist | 174400000X | L9092 | Texas |
Profile Details
| NPI number | 1912962028 |
|---|---|
| LBN Legal business name | Bastasch, Michael David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 20th, 2006 |
| Last updated | Jun 23rd, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912962028 | NPPES |
| Texas | MEDICAID | 16796101 |
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