MEDICARE: ASIM MUSHTAQ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	310966	NY
2	207RG0100X	Gastroenterology Physician	MD486655	PA
3	208M00000X	Hospitalist Physician	48460	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	6035999	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1043449036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASIM MUSHTAQ M.D.

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:	585-922-4136
Fax Number	:	585-922-5761

Provider Business Practice Location Address
First Line	:	1425 PORTLAND AVE; WILSON BUILDING
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621
Country	:	US
Telephone Number	:	585-922-4136
Fax Number	:	585-922-5761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	02/03/2026

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Directions to “ ASIM MUSHTAQ M.D.” Practice Location

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