1922003565 NPI number — KARAN K BHATIA M.D.

Table of content: KARAN K BHATIA M.D. (NPI 1922003565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922003565 NPI number — KARAN K BHATIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHATIA
Provider First Name:
KARAN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922003565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOND CLINIC, P.A.
Provider Second Line Business Mailing Address:
500 EAST CENTRAL AVENUE
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-293-1191
Provider Business Mailing Address Fax Number:
863-293-3635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BOND CLINIC, P.A.
Provider Second Line Business Practice Location Address:
500 EAST CENTRAL AVENUE
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-293-1191
Provider Business Practice Location Address Fax Number:
863-293-3635
Provider Enumeration Date:
06/20/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME44221 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006335700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".