MEDICARE: DR. BILQUIS IMTIAZ KHOT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	E4714	AR

General Provider Information

NPI Number	:	1407810989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILQUIS IMTIAZ KHOT MD

Provider Business Mailing Address
First Line	:	1801 FOREST HILLS BLVD.
Second Line	:	STE. 201
City	:	BELLA VISTA
State	:	AR
Zip	:	72715
Country	:	US
Telephone Number	:	479-876-6566
Fax Number	:	479-876-2933

Provider Business Practice Location Address
First Line	:	1801 FOREST HILLS BLVD.
Second Line	:	STE. 201
City	:	BELLA VISTA
State	:	AR
Zip	:	72715
Country	:	US
Telephone Number	:	479-876-6566
Fax Number	:	479-876-2933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	09/16/2009

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