Provider Demographics
NPI:1629269972
Name:BASANI, SHAILESH RAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILESH
Middle Name:RAM
Last Name:BASANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5669 PEACHTREE DUNWOODY RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1719
Mailing Address - Country:US
Mailing Address - Phone:404-410-3970
Mailing Address - Fax:404-844-4818
Practice Address - Street 1:5669 PEACHTREE DUNWOODY RD STE 240
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1719
Practice Address - Country:US
Practice Address - Phone:404-410-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA84952207R00000X, 207RN0300X
IN01071094A207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine