Provider Demographics
NPI:1639231350
Name:BHOLE, SUNIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:
Last Name:BHOLE
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 1:8953 OLD SOUTHWICK PASS
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7140
Mailing Address - Country:US
Mailing Address - Phone:770-664-7379
Mailing Address - Fax:770-558-6798
Practice Address - Street 1:3215 MCCLURE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3223
Practice Address - Country:US
Practice Address - Phone:678-584-6786
Practice Address - Fax:678-584-6719
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024513208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD28921Medicare UPIN
GA25BBFSLMedicare ID - Type Unspecified