Healthcare Provider Details

I. General information

NPI: 1972348803
Provider Name (Legal Business Name): BEENISH SOHAIL BHUTTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

3440 N. BOARD STREET DEPARTMENT OF NEPHROLOGY KRESGE BUILDING, STE 100 WEST
PHILADELPHIA PA
19140
US

V. Phone/Fax

Practice location:
  • Phone: 888-484-3258
  • Fax:
Mailing address:
  • Phone: 215-707-7937
  • Fax: 215-707-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT231924
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: