Healthcare Provider Details

I. General information

NPI: 1386607513
Provider Name (Legal Business Name): ASISH MUKHERJEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 MONCLOVA RD SUITE 203
MAUMEE OH
43537-1875
US

IV. Provider business mailing address

1 SEAGATE SUITE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 419-893-2622
  • Fax: 419-893-2755
Mailing address:
  • Phone: 567-585-1983
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD427683
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number072465
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: