Healthcare Provider Details

I. General information

NPI: 1396016705
Provider Name (Legal Business Name): AMIT KETAN BHANDUTIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CANAL ST
NEW ORLEANS LA
70112-3018
US

IV. Provider business mailing address

1542 TULANE AVE., BOX T6-7
NEW ORLEANS LA
70112
US

V. Phone/Fax

Practice location:
  • Phone: 504-523-0804
  • Fax: 267-361-0761
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number324217
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number324217
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: