Provider Demographics
NPI:1538153184
Name:BASU, ASISH K (MD)
Entity type:Individual
Prefix:DR
First Name:ASISH
Middle Name:K
Last Name:BASU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 VAN BUREN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1534
Mailing Address - Country:US
Mailing Address - Phone:419-435-7734
Mailing Address - Fax:419-437-6623
Practice Address - Street 1:501 VAN BUREN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1534
Practice Address - Country:US
Practice Address - Phone:419-435-7734
Practice Address - Fax:419-437-6623
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064587207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH14-52073OtherUHC
OH4528172OtherAETNA
OH000000387005OtherANTHEM
OH0978170Medicaid
OHP00294496OtherRRMC
OHP00294496OtherRRMC
OH4528172OtherAETNA