Provider Demographics
NPI:1598823122
Name:BHUTA, ISHWARLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISHWARLAL
Middle Name:
Last Name:BHUTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 PINE STREET
Mailing Address - Street 2:SUITE 801
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-263-1026
Mailing Address - Fax:334-263-1027
Practice Address - Street 1:1722 PINE STREET
Practice Address - Street 2:SUITE 801
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-263-1026
Practice Address - Fax:334-263-1027
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6376208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000000434Medicaid
00434Medicare ID - Type Unspecified
C76348Medicare UPIN