Provider Demographics
NPI:1104852680
Name:ASUDANI, KUSUM B (MD)
Entity Type:Individual
Prefix:
First Name:KUSUM
Middle Name:B
Last Name:ASUDANI
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 1:2640 E BARNETT ROAD E333
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-282-6770
Mailing Address - Fax:541-282-6771
Practice Address - Street 1:2825 E BARNETT ROAD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-732-5545
Practice Address - Fax:541-732-5548
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221888207R00000X
ORMD26855208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR838334035OtherBCBS-ROSEBURG
OR241344Medicaid
OR838366033OtherBCBS-MCMINNVILLE
OR844477041OtherBCBS-GRANTS PASS
OR858464040OtherBCBS-SPRINGFIELD
ORP00403585OtherRAIL ROAD MEDICARE
OR858463032OtherBCBS-MEDFORD
OR838366033OtherBCBS-MCMINNVILLE
ORR136670Medicare PIN
OR241344Medicaid