Healthcare Provider Details

I. General information

NPI: 1528066230
Provider Name (Legal Business Name): ABDUL L. BHATTI MD FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 ZEAGLER DR
PALATKA FL
32177-3813
US

IV. Provider business mailing address

524 ZEAGLER DR
PALATKA FL
32177-3813
US

V. Phone/Fax

Practice location:
  • Phone: 386-328-5811
  • Fax: 386-328-9813
Mailing address:
  • Phone: 386-328-5811
  • Fax: 386-328-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 23062
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME23062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: