Basic Information
Provider Information
NPI: 1053577890
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHATTI
FirstName: ZAGUM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2487 S GILBERT RD
Address2: STE 106 PMB 406
City: GILBERT
State: AZ
PostalCode: 85295
CountryCode: US
TelephoneNumber: 4804474870
FaxNumber: 4805644904
Practice Location
Address1: 1302 N STANTON ST
Address2:  
City: EL PASO
State: TX
PostalCode: 799024122
CountryCode: US
TelephoneNumber: 9152481277
FaxNumber: 9158459072
Other Information
ProviderEnumerationDate: 07/31/2008
LastUpdateDate: 08/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XQ3852TXN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0204XQ3852TXY Allopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology

No ID Information.


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