Healthcare Provider Details

I. General information

NPI: 1659343614
Provider Name (Legal Business Name): OMKAR N BHATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 FAIRWAY STREET
BOWLING GREEN KY
42103-2477
US

IV. Provider business mailing address

201 PARK ST
BOWLING GREEN KY
42101-1759
US

V. Phone/Fax

Practice location:
  • Phone: 270-796-3910
  • Fax: 270-842-7177
Mailing address:
  • Phone: 270-781-5111
  • Fax: 270-783-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number18895
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18895
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: