Provider Demographics
NPI:1447867619
Name:BASHAR YALLDO MD PLC
Entity type:Organization
Organization Name:BASHAR YALLDO MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:YALLDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-330-7098
Mailing Address - Street 1:14700 FARMINGTON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14700 FARMINGTON RD STE 105
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5434
Practice Address - Country:US
Practice Address - Phone:248-330-7098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891133575OtherNPI