Individual
PROMIL BHUTANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2101 ELM ST N, FARGO, ND 58102-2417
(701) 335-4380
Mailing address
2101 ELM ST N, FARGO, ND 58102-2417
(701) 335-4380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
52748
MN
207Q00000X
Family Medicine Physician
MD2006-0509
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03073335
—
NM
05
—
1164581625
—
MN
01
—
MD2006-0509
LICENSE
NM
01
—
NM001P81
BCBS
NM
01
—
P00405998
RAILROAD MEDICARE
NM
Enumeration date
12/08/2006
Last updated
11/26/2025
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