Provider Demographics
NPI:1659343614
Name:BHATT, OMKAR N (MD)
Entity Type:Individual
Prefix:DR
First Name:OMKAR
Middle Name:N
Last Name:BHATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:270-783-3750
Practice Address - Street 1:1225 FAIRWAY STREET
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2477
Practice Address - Country:US
Practice Address - Phone:270-796-3910
Practice Address - Fax:270-842-7177
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18895207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00730185OtherRAILROAD MEDICARE
KY64188956Medicaid
C69542Medicare UPIN
0622338Medicare PIN