Healthcare Provider Details

I. General information

NPI: 1265959795
Provider Name (Legal Business Name): BHATTI GI SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 WHITE OAK DR
CHASKA MN
55318
US

IV. Provider business mailing address

1447 WHITE OAK DR
CHASKA MN
55318-2525
US

V. Phone/Fax

Practice location:
  • Phone: 952-368-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2039
License Number StateMN

VIII. Authorized Official

Name: AHSAN BHATTI
Title or Position: M.D.
Credential:
Phone: 952-368-3800