Individual
DHIMAN BASU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5009 HERITAGE AVE, COLLEYVILLE, TX 76034-5913
(817) 590-0880
(817) 590-0199
Mailing address
5009 HERITAGE AVE, COLLEYVILLE, TX 76034-5913
(817) 590-0880
(817) 590-0199
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301085466
MI
207RR0500X
Rheumatology Physician
4301085466
MI
207RR0500X
Rheumatology Physician
Primary
M7849
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191467301
—
TX
Enumeration date
03/26/2007
Last updated
03/01/2018
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