Provider Demographics
NPI:1427374180
Name:VASAMSETTI, ANUSHA
Entity Type:Individual
Prefix:
First Name:ANUSHA
Middle Name:
Last Name:VASAMSETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 N MCCLURG CT
Mailing Address - Street 2:UNIT 4702
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5359
Mailing Address - Country:US
Mailing Address - Phone:601-473-5990
Mailing Address - Fax:
Practice Address - Street 1:2101 BURLINGTON BEACH RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-1665
Practice Address - Country:US
Practice Address - Phone:219-462-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074342A207W00000X
IL036132831207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology