Provider Demographics
NPI:1902804321
Name:BASEDOW, WILLIAM K (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:K
Last Name:BASEDOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2538
Mailing Address - Country:US
Mailing Address - Phone:740-532-3100
Mailing Address - Fax:740-532-8558
Practice Address - Street 1:2301 S 7TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2542
Practice Address - Country:US
Practice Address - Phone:740-532-3100
Practice Address - Fax:740-532-8558
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0919171Medicaid
OH0919171Medicaid
OHBA0740732Medicare PIN