Provider Demographics
NPI:1598560427
Name:BASUDE, VISHNU
Entity type:Individual
Prefix:
First Name:VISHNU
Middle Name:
Last Name:BASUDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 CONCHO DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4657
Mailing Address - Country:US
Mailing Address - Phone:972-302-7271
Mailing Address - Fax:
Practice Address - Street 1:1315 CONCHO DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4657
Practice Address - Country:US
Practice Address - Phone:972-302-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program