Provider Demographics
NPI:1942262829
Name:MISHRA, ASHUTOSH K (MD)
Entity Type:Individual
Prefix:MR
First Name:ASHUTOSH
Middle Name:K
Last Name:MISHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 282
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-537-1892
Mailing Address - Fax:901-537-1898
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2131
Practice Address - Country:US
Practice Address - Phone:901-537-1892
Practice Address - Fax:901-537-1892
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS18404207R00000X
TN38109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4153896OtherBLUECROSS
TN3897916Medicaid
MSP00380572OtherMEDICARE RAILROAD
TN3897916Medicare PIN
MSH26459Medicare UPIN
TN3897916Medicaid