Individual
BHAVANA BHANOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11315 BRIDGEPORT WAY SW, LAKEWOOD, WA 98499-3004
(253) 426-6341
(253) 426-6344
Mailing address
11315 BRIDGEPORT WAY SW, LAKEWOOD, WA 98499-3004
(253) 426-6341
(253) 426-6344
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00046092
WA
208M00000X
Hospitalist Physician
Primary
MD00046092
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0249186
STATE L&I
WA
05
—
1032546
—
WA
01
—
P00773458
RAILROAD
WA
Enumeration date
07/12/2006
Last updated
02/08/2021
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