Individual
MALIK MOSSA-BASHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9998 CROSSPOINT BLVD STE 200, INDIANAPOLIS, IN 46256-3307
(317) 579-2150
(317) 579-2130
Mailing address
9998 CROSSPOINT BLVD STE 200, INDIANAPOLIS, IN 46256-3307
(317) 579-2150
(317) 579-2130
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01089176A
IN
2085R0202X
Diagnostic Radiology Physician
D88654
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01089176A
STATE LICENSE
IN
01
—
43015045720
STATE LICENSE
MI
01
—
D88654
LICENSE
MD
Enumeration date
03/31/2014
Last updated
06/12/2023
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