Healthcare Provider Details

I. General information

NPI: 1538153184
Provider Name (Legal Business Name): ASISH K BASU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 VAN BUREN ST SUITE 206
FOSTORIA OH
44830-1534
US

IV. Provider business mailing address

501 VAN BUREN ST SUITE 206
FOSTORIA OH
44830-1534
US

V. Phone/Fax

Practice location:
  • Phone: 419-435-7734
  • Fax: 419-437-6623
Mailing address:
  • Phone: 419-435-7734
  • Fax: 419-437-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35064587
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35064587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: