MEDICARE: DR. BIBHUTI B DAS 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	207RA0002X	Adult Congenital Heart Disease Physician	28044	MS
2	2080P0202X	Pediatric Cardiology Physician	ME134234	FL
3	2080P0202X	Pediatric Cardiology Physician	P0191	TX

General Provider Information

NPI Number	:	1316943376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIBHUTI B DAS MD

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR STE 289
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3712
Country	:	US
Telephone Number	:	210-614-3264
Fax Number	:	210-615-0888

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	05/20/2025

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