Healthcare Provider Details

I. General information

NPI: 1871608240
Provider Name (Legal Business Name): DEO KALYAN BHATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 EMMETT F LOWRY EXPY STE C C-103
TEXAS CITY TX
77591-2001
US

IV. Provider business mailing address

3 PONDVIEW COURT
MANSFIELD TX
76063-5471
US

V. Phone/Fax

Practice location:
  • Phone: 409-938-2234
  • Fax: 409-938-2243
Mailing address:
  • Phone: 817-453-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD8997
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD8997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: