Basic Information
| Provider Information | |||||||||
| NPI: | 1225249113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHATTI | ||||||||
| FirstName: | SOKUN | ||||||||
| MiddleName: | KY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 700 PRIDES XING STE 200 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197136109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029980300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 700 PRIDES XING STE 200 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197136109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029980300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 2010-02132 | NC | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207R00000X | 57009457 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207K00000X | C1-0012638 | DE | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 000000225038 | 01 | OH | UNISON | OTHER | 9759062 | 01 | OH | AETNA | OTHER | 2765039 | 05 | OH | MEDICAID | 751101 | 01 | OH | BUCKEYE | OTHER | P00412271 | 01 | OH | MEDICARE RAILROAD | OTHER | 000000530748 | 01 | OH | ANTHEM | OTHER | 414947 | 01 | OH | WELLCARE | OTHER |