Provider Demographics
NPI:1265436943
Name:VRUSHAB, BASANTI RAJESH (MD)
Entity type:Individual
Prefix:DR
First Name:BASANTI
Middle Name:RAJESH
Last Name:VRUSHAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 PRECINCT LINE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3345
Mailing Address - Country:US
Mailing Address - Phone:817-281-4910
Mailing Address - Fax:817-281-3107
Practice Address - Street 1:1615 PRECINCT LINE RD STE 103
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3345
Practice Address - Country:US
Practice Address - Phone:817-281-4910
Practice Address - Fax:817-281-3107
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2023-01-18
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TXM6940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine