Provider Demographics
NPI:1699722348
Name:ASURU, AGATHA I (MD)
Entity type:Individual
Prefix:DR
First Name:AGATHA
Middle Name:I
Last Name:ASURU
Suffix:
Gender:F
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:P.O. BOX 11523
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1523
Mailing Address - Country:US
Mailing Address - Phone:205-212-5600
Mailing Address - Fax:205-212-5610
Practice Address - Street 1:2401 15TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35234
Practice Address - Country:US
Practice Address - Phone:205-841-7760
Practice Address - Fax:205-212-5610
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024812207R00000X
AL24812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934073Medicaid
AL51556841Medicare ID - Type Unspecified
AL009934073Medicaid