Healthcare Provider Details

I. General information

NPI: 1508854563
Provider Name (Legal Business Name): RAHUL BHATIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/31/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7517 S MCCLINTOCK DR STE 103
TEMPE AZ
85283-5011
US

IV. Provider business mailing address

7557 SOUTH MCCLINTOCK DRIVE, SUITE 103
TEMPE AZ
85283
US

V. Phone/Fax

Practice location:
  • Phone: 602-610-7337
  • Fax: 602-536-4102
Mailing address:
  • Phone: 602-610-7337
  • Fax: 602-536-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number50525
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD526810
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: