MEDICARE: DR. ASISH K BASU 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	207R00000X	Internal Medicine Physician	35064587	OH
2	207RC0000X	Cardiovascular Disease Physician	35064587	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14-52073	OTHER	OH	UHC
2	4528172	OTHER	OH	AETNA
3	000000387005	OTHER	OH	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	P00294496	OTHER	OH	RRMC

General Provider Information

NPI Number	:	1538153184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASISH K BASU M.D.

Provider Business Mailing Address
First Line	:	501 VAN BUREN ST
Second Line	:	SUITE 206
City	:	FOSTORIA
State	:	OH
Zip	:	44830-1534
Country	:	US
Telephone Number	:	419-435-7734
Fax Number	:	419-437-6623

Provider Business Practice Location Address
First Line	:	501 VAN BUREN ST
Second Line	:	SUITE 206
City	:	FOSTORIA
State	:	OH
Zip	:	44830-1534
Country	:	US
Telephone Number	:	419-435-7734
Fax Number	:	419-437-6623

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	03/22/2012

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Directions to “ DR. ASISH K BASU M.D.” Practice Location

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