MEDICARE: AVI DESHMUKH 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	208800000X	Urology Physician	H1067	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	340008824	OTHER	TX	RAILROAD MEDICARE PROV NO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9792483001	OTHER	TN	CIGNA PROVIDER NUMBER
4	814764	OTHER	TN	BCBS PROVIDER NUMBER
5	4458935	OTHER	TX	AETNA PROVIDER NUMBER
6	111591100	OTHER	TX	FIRST CARE PROVIDER NUMBE

General Provider Information

NPI Number	:	1386640415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVI DESHMUKH M.D.

Provider Business Mailing Address
First Line	:	805 HILL BLVD STE 106-107
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-1481
Country	:	US
Telephone Number	:	817-599-3690
Fax Number	:	817-599-6633

Provider Business Practice Location Address
First Line	:	805 HILL BLVD STE 106-107
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048
Country	:	US
Telephone Number	:	817-599-3690
Fax Number	:	817-599-6633

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/24/2020

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Directions to “ AVI DESHMUKH M.D.” Practice Location

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