Provider Demographics
NPI:1215987359
Name:ACHARYA, ASHISH A (MD)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:A
Last Name:ACHARYA
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 1:1600 W COLLEGE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3575
Mailing Address - Country:US
Mailing Address - Phone:214-689-7806
Mailing Address - Fax:214-689-5970
Practice Address - Street 1:1600 W COLLEGE ST STE 130
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3575
Practice Address - Country:US
Practice Address - Phone:214-689-7806
Practice Address - Fax:214-689-5970
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48536-020207RI0200X
TXM3837207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34804000Medicaid
TX183932601Medicaid
WI001002780Medicare ID - Type UnspecifiedMILWAUKEE COUNTY
TX830708Medicare PIN
WI34804000Medicaid
TX8JQ7Q8Medicare PIN
TX183932601Medicaid