Basic Information
| Provider Information | |||||||||
| NPI: | 1407826233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASU | ||||||||
| FirstName: | ASHISH | ||||||||
| MiddleName: | KUMAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 2424 DANVILLE RD SW | ||||||||
| Address2: | SUITE L | ||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356034280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563510688 | ||||||||
| FaxNumber: | 2563538894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 09/25/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 22653 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 112957 | 05 | AL | MEDICAID | 4041982 | 01 | TN | BCBS | OTHER | 510-49222 | 01 | AL | BCBS | OTHER | 112956 | 05 | AL | MEDICAID | 051509636 | 05 | AL | MEDICAID | 112949 | 05 | AL | MEDICAID | 25-10769 | 01 | UNITED HEALTHCARE | OTHER | 515-98439 | 01 | AL | BCBS | OTHER | 515-98440 | 01 | AL | BCBS | OTHER | 515-98442 | 01 | AL | BCBS | OTHER | 510-49221 | 01 | AL | BCBS | OTHER | 112943 | 05 | AL | MEDICAID | 112953 | 05 | AL | MEDICAID | 515-98443 | 01 | AL | BCBS | OTHER | 51509636 | 01 | AL | BCBS | OTHER | 060068573 | 01 | RAILROAD MEDICARE | OTHER | 112947 | 05 | AL | MEDICAID | 4469236 | 01 | AETNA | OTHER |