Healthcare Provider Details
I. General information
NPI: 1083055131
Provider Name (Legal Business Name): GUTHEALTH MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/17/2013
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
55 GREEN AVE
BROOKLYN NY
11238
US
IV. Provider business mailing address
297 ADELPHI ST
BROOKLYN NY
11205-4602
US
V. Phone/Fax
- Phone: 718-398-2121
- Fax:
- Phone: 718-398-2121
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RG0100X |
| Taxonomy | Gastroenterology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
KIRAN
K
BHAT
Title or Position: PRSIDENT
Credential: M.D.
Phone: 917-385-3960