Provider Demographics
NPI:1548422918
Name:BAG, ASIM KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ASIM
Middle Name:KUMAR
Last Name:BAG
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 1:262 DANNY THOMAS PL # MS 515
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-595-3442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL312162085N0700X
TN576522085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051120811OtherBCBS
AL133051Medicaid
AL051120806OtherBCBS
AL051120810OtherBCBS
AL051120813OtherBCBS
AL133052Medicaid
AL051120803OtherBCBS
AL051120804OtherBCBS
AL133044Medicaid
AL133047Medicaid
AL051120807OtherBCBS
AL051120809OtherBCBS
AL133046Medicaid
AL133049Medicaid
AL133055Medicaid
MS01481216Medicaid
AL051120805OtherBCBS
AL133043Medicaid
AL133053Medicaid
AL133060Medicaid
AL051120812OtherBCBS
AL102I363478Medicare PIN