Provider Demographics
NPI:1508585811
Name:BHETWAL, KRISHNA PRASAD
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:PRASAD
Last Name:BHETWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 28TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4589
Mailing Address - Country:US
Mailing Address - Phone:701-630-9912
Mailing Address - Fax:
Practice Address - Street 1:7220 28TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4589
Practice Address - Country:US
Practice Address - Phone:701-630-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist