Healthcare Provider Details

I. General information

NPI: 1245714187
Provider Name (Legal Business Name): KUNAL BHUTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W MARKET ST STE 16
ATHENS AL
35611-2454
US

IV. Provider business mailing address

1005 W MARKET ST STE 16
ATHENS AL
35611-2454
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-0801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD46560
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: