MEDICARE: DR. PUNIT BHUTWALA MD

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	207R00000X	Internal Medicine Physician	30069	TN
2	207R00000X	Internal Medicine Physician	45176	GA

General Provider Information

NPI Number	:	1316919384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PUNIT BHUTWALA MD

Provider Business Mailing Address
First Line	:	PO BOX 11407
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-0100
Country	:	US
Telephone Number	:	706-861-0004
Fax Number	:	706-861-0050

Provider Business Practice Location Address
First Line	:	609 MAGNOLIA VALE DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2185
Country	:	US
Telephone Number	:	423-825-1991
Fax Number	:

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	01/31/2019

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