Individual
IKJOT S. BHUTANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF ANATOMIC PATHOLOGY, WORCESTER, MA 01655-0002
(508) 793-6100
(508) 793-6110
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
262257
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110114620A
—
MA
Enumeration date
04/05/2011
Last updated
01/24/2017
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