Provider Demographics
NPI:1932430071
Name:ABDUL LATEEF BHATTI, MD, PA
Entity Type:Organization
Organization Name:ABDUL LATEEF BHATTI, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BHATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:386-328-5811
Mailing Address - Street 1:524 ZEAGLER DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3813
Mailing Address - Country:US
Mailing Address - Phone:386-328-5811
Mailing Address - Fax:386-328-9813
Practice Address - Street 1:524 ZEAGLER DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3813
Practice Address - Country:US
Practice Address - Phone:386-328-5811
Practice Address - Fax:386-328-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056789200Medicaid
54039OtherBLUE CROSS/BLUE SHIELD
FL056789200Medicaid
FL54039Medicare PIN