Provider Demographics
NPI:1861524613
Name:BHATKI, AMOL MADHAV (MD)
Entity type:Individual
Prefix:DR
First Name:AMOL
Middle Name:MADHAV
Last Name:BHATKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1805
Mailing Address - Country:US
Mailing Address - Phone:469-800-7700
Mailing Address - Fax:469-800-7710
Practice Address - Street 1:3600 GASTON AVE STE 502
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1805
Practice Address - Country:US
Practice Address - Phone:469-800-7700
Practice Address - Fax:469-800-7710
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 433840207Y00000X
TXN2947207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI 2121006-01Medicaid
8L15414Medicare PIN
TXTPI 2121006-01Medicaid