Provider Demographics
NPI:1699764530
Name:BASU, ABHIJIT (MD)
Entity type:Individual
Prefix:
First Name:ABHIJIT
Middle Name:
Last Name:BASU
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 1:1940 NE 47TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7711
Mailing Address - Country:US
Mailing Address - Phone:954-772-4553
Mailing Address - Fax:954-771-2372
Practice Address - Street 1:1940 NE 47TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7711
Practice Address - Country:US
Practice Address - Phone:954-772-4553
Practice Address - Fax:954-771-2372
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92926208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2696731OtherCIGNA
FL03577OtherBLUE CROSS BLUE SHIELD
FL53733OtherNEIGHBORHOOD HEALTH
FLP00268555OtherRAILROAD MEDICARE
FL298286OtherAVMED
7276705OtherAETNA
FLI36343OtherVISTA
FLP00268555OtherRAILROAD MEDICARE
FL298286OtherAVMED
FLI36343OtherVISTA