Provider Demographics
NPI:1205819364
Name:BHUTIANI, INDER K (MD)
Entity type:Individual
Prefix:
First Name:INDER
Middle Name:K
Last Name:BHUTIANI
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 1:2715 WEST VIRGINIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6327
Mailing Address - Country:US
Mailing Address - Phone:813-662-6024
Mailing Address - Fax:813-514-1257
Practice Address - Street 1:200 AVENUE F NE
Practice Address - Street 2:DEPT. OF RADIATION ONCOLOGY
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-297-1865
Practice Address - Fax:863-291-6025
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME423882085R0203X
NY144735-12085R0203X
PAMD049357L2085R0203X
MDD00246122085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039337100Medicaid
FLP00909698OtherRR MEDICARE
300112175OtherRAILROAD MEDICARE
FL53704OtherBCBS
FL53704WMedicare PIN
FL039337100Medicaid
53704VMedicare PIN
FL53704OtherBCBS
53704AMedicare PIN
FL53704XMedicare PIN
FL53704VMedicare PIN