Basic Information
| Provider Information | |||||||||
| NPI: | 1205819364 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BHUTIANI | ||||||||
| FirstName: | INDER | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2715 WEST VIRGINIA AVENUE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136626024 | ||||||||
| FaxNumber: | 8135141257 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 AVENUE F NE | ||||||||
| Address2: | DEPT. OF RADIATION ONCOLOGY | ||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338814131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632971865 | ||||||||
| FaxNumber: | 8632916025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 10/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0203X | ME42388 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0203X | 144735-1 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0203X | MD049357L | PA | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0203X | D0024612 | MD | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 039337100 | 05 | FL | MEDICAID | P00909698 | 01 | FL | RR MEDICARE | OTHER | 300112175 | 01 | RAILROAD MEDICARE | OTHER | 53704 | 01 | FL | BCBS | OTHER |