Basic Information
| Provider Information | |||||||||
| NPI: | 1538153184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASU | ||||||||
| FirstName: | ASISH | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 VAN BUREN ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | FOSTORIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448301534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194357734 | ||||||||
| FaxNumber: | 4194376623 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 VAN BUREN ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | FOSTORIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448301534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194357734 | ||||||||
| FaxNumber: | 4194376623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 03/22/2012 | ||||||||
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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 | 207R00000X | 35064587 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 35064587 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 14-52073 | 01 | OH | UHC | OTHER | 4528172 | 01 | OH | AETNA | OTHER | 000000387005 | 01 | OH | ANTHEM | OTHER | 0978170 | 05 | OH | MEDICAID | P00294496 | 01 | OH | RRMC | OTHER |