MEDICARE: KHUSHVANT BHOLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	26771	AZ

General Provider Information

NPI Number	:	1265438220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHUSHVANT BHOLA M.D.

Provider Business Mailing Address
First Line	:	6585 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5614
Country	:	US
Telephone Number	:	520-229-2080
Fax Number	:	520-229-2092

Provider Business Practice Location Address
First Line	:	4745 E CAMP LOWELL DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1256
Country	:	US
Telephone Number	:	602-273-6770
Fax Number	:	602-889-0489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	05/19/2023

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