Healthcare Provider Details

I. General information

NPI: 1841265071
Provider Name (Legal Business Name): TARIKA BHUTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 INDEPENDENCE DR
BIRMINGHAM AL
35209-4167
US

IV. Provider business mailing address

3055 INDEPENDENCE DR
BIRMINGHAM AL
35209-4167
US

V. Phone/Fax

Practice location:
  • Phone: 205-414-1368
  • Fax: 205-414-1367
Mailing address:
  • Phone: 205-414-1368
  • Fax: 205-414-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD00025241
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: