Healthcare Provider Details

I. General information

NPI: 1932430071
Provider Name (Legal Business Name): ABDUL LATEEF BHATTI, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
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 TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABDUL L BHATTI
Title or Position: OWNER/PRESIDENT
Credential: M.D., F.A.C.C.
Phone: 386-328-5811