Provider Demographics
NPI:1215484647
Name:ASARKAR, AMEYA A (MD)
Entity type:Individual
Prefix:
First Name:AMEYA
Middle Name:A
Last Name:ASARKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130
Mailing Address - Country:US
Mailing Address - Phone:318-813-2690
Mailing Address - Fax:318-813-2491
Practice Address - Street 1:1501 KINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71130
Practice Address - Country:US
Practice Address - Phone:318-813-2690
Practice Address - Fax:318-813-2692
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262818207Y00000X
LA310582207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology