Provider Demographics
NPI:1386607513
Name:MUKHERJEE, ASISH (MD)
Entity type:Individual
Prefix:DR
First Name:ASISH
Middle Name:
Last Name:MUKHERJEE
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 1:1 SEAGATE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1983
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:5705 MONCLOVA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1875
Practice Address - Country:US
Practice Address - Phone:419-893-2622
Practice Address - Fax:419-893-2755
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427683208C00000X
OH072465208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2561124Medicaid
G-59336Medicare UPIN