Individual
BASEM MOURAD LABIB MISHRIKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 MEDICAL PARK RD STE 506, COLUMBIA, SC 29203-6876
(803) 434-3930
(803) 540-1050
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2017-00499
NC
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
87142
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326486465
—
NC
01
—
19QHE
BCBS
NC
01
—
NCX458A
MEDICARE
NC
Enumeration date
06/11/2013
Last updated
08/02/2022
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