Individual
THOMAS MICHAEL BASCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2147 HEALTH DR SW STE 100, WYOMING, MI 49519-9675
(616) 281-1600
(616) 281-2247
Mailing address
5555 GLENWOOD HILLS PKWY SE STE 2, GRAND RAPIDS, MI 49512-2091
(616) 940-2662
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
4301063063
MI
208VP0014X
Interventional Pain Medicine Physician
Primary
4301063063
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16642
HEALTH PLAN OF MICHIGAN
—
05
—
4514558-10
—
MI
05
—
4606551-10
—
MI
05
—
4606560-10
—
MI
01
—
5070255
CIGNA
—
01
—
550415528
BLUE CROSS BLUE SHIELD
MI
01
—
7000034231
PRIORITY HEALTH
—
01
—
7624881
AETNA
—
01
—
P00061534
RAIL ROAD MEDICARE
—
Enumeration date
04/10/2006
Last updated
05/06/2021
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