Healthcare Provider Details

I. General information

NPI: 1548422918
Provider Name (Legal Business Name): ASIM KUMAR BAG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105
US

IV. Provider business mailing address

262 DANNY THOMAS PL # MS 515
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number31216
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number57652
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number57652
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: