Provider Demographics
NPI:1962815068
Name:BHAT, SUNIL (DO)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:BHAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 CHARLOTTE ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2741
Mailing Address - Country:US
Mailing Address - Phone:406-625-3058
Mailing Address - Fax:406-578-3602
Practice Address - Street 1:2135 CHARLOTTE ST STE 1A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2741
Practice Address - Country:US
Practice Address - Phone:406-625-3058
Practice Address - Fax:406-578-3602
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16491204D00000X, 207Q00000X
MT101361207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty