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General NPI Number Information
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NPI Number | 1194993147
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Entity Type | Individual
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Provider Name | ABHIJEET BASOOR MD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 1901 S CEDAR ST STE 301
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City | TACOMA
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State | WA
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Zip | 98405-2302
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Country | US
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Telephone | 253-572-7320
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Fax | 253-627-3191
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Provider Business Mailing Address
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Address Line | PO BOX 5299 MS: 820-5-PCO
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City | TACOMA
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State | WA
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Zip | 98415-0299
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301087556
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 28008
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 28008
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD61605779
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License Number State | WA
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