Provider Demographics
NPI:1538277587
Name:BASSI, TARUN (MD)
Entity type:Individual
Prefix:
First Name:TARUN
Middle Name:
Last Name:BASSI
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 1:11110 N TATUM BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1607
Mailing Address - Country:US
Mailing Address - Phone:602-354-3311
Mailing Address - Fax:602-354-3751
Practice Address - Street 1:11110 N TATUM BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1607
Practice Address - Country:US
Practice Address - Phone:602-354-3311
Practice Address - Fax:602-354-3751
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46926207R00000X
AZ56559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ114227Medicaid
WI34540700Medicaid
I12561Medicare UPIN