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Individual

CARLA A. BASTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
29 MINNEWAWA DR, TIMBERLAKE, OH 44095-1928
(440) 479-1669
Mailing address
29 MINNEWAWA DR, TIMBERLAKE, OH 44095-1928
(440) 479-1669

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34003592
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0729733
OH
01
343003592
LICENSE
OH
Enumeration date
11/14/2006
Last updated
09/05/2019
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