Individual
JOHN J BASICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6516
(414) 454-6789
Mailing address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6516
(414) 454-6789
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
13387-033
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
13387-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100223076
—
WI
Enumeration date
12/13/2022
Last updated
04/12/2023
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