Provider Demographics
NPI:1144250234
Name:BHAT, SUMAN ASHOK (MD)
Entity type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:ASHOK
Last Name:BHAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3400
Mailing Address - Country:US
Mailing Address - Phone:813-237-1958
Mailing Address - Fax:813-237-8147
Practice Address - Street 1:613 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3400
Practice Address - Country:US
Practice Address - Phone:813-237-1958
Practice Address - Fax:813-237-8147
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00493692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045959300Medicaid
FL04422Medicare ID - Type UnspecifiedMEDICARE ID #
FL045959300Medicaid