Provider Demographics
NPI:1689692352
Name:BHUTA, VIENDRA (MD)
Entity Type:Individual
Prefix:
First Name:VIENDRA
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 1:8660 W FLAGLER ST
Mailing Address - Street 2:#200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2031
Mailing Address - Country:US
Mailing Address - Phone:305-227-3884
Mailing Address - Fax:305-554-4833
Practice Address - Street 1:8840 SW 40TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5482
Practice Address - Country:US
Practice Address - Phone:305-227-3884
Practice Address - Fax:305-554-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23063207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95226Medicare ID - Type Unspecified
FLD78893Medicare UPIN