Healthcare Provider Details

I. General information

NPI: 1154633600
Provider Name (Legal Business Name): DEEPAK ASTI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 YORK DR
DESOTO TX
75115-2043
US

IV. Provider business mailing address

2101 SHANNON OXMOOR RD # 270
SHANNON AL
35142-2000
US

V. Phone/Fax

Practice location:
  • Phone: 972-572-1600
  • Fax:
Mailing address:
  • Phone: 205-880-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number272352
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberT4612
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number272352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: