Provider Demographics
NPI:1528066230
Name:BHATTI, ABDUL L (MD FACC)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:L
Last Name:BHATTI
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 ZEAGLER DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3813
Mailing Address - Country:US
Mailing Address - Phone:386-328-5811
Mailing Address - Fax:386-328-9813
Practice Address - Street 1:524 ZEAGLER DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3813
Practice Address - Country:US
Practice Address - Phone:386-328-5811
Practice Address - Fax:386-328-9813
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 23062207R00000X
FLME23062207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056789200Medicaid
FL54039OtherBLUE CROSS/BLUE SHIELD
FL056789200Medicaid
FL54039Medicare PIN