Provider Demographics
NPI:1518661289
Name:BIJU, ASHISH THEKKEKARA (DPM)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:THEKKEKARA
Last Name:BIJU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 JACKSON SHOALS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4065
Mailing Address - Country:US
Mailing Address - Phone:678-619-7860
Mailing Address - Fax:
Practice Address - Street 1:2790 GODWIN BLVD STE 355
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8173
Practice Address - Country:US
Practice Address - Phone:757-635-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program