Promil Bhutani, MD
Individual provider Active NPI Family Medicine Physician · Fargo, ND
NPI 1164581625 · NPPES record last updated Nov 26, 2025
Key facts
- NPI
- 1164581625
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 52748 (MN)
- Practice address
- 2101 Elm St N
Fargo, ND 58102-2417 - Phone
- (701) 335-4380
- NPI assigned
- Dec 8, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210422003044 | ND | Order and Referring Only - Family Practice |
3173627387 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52748 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pecos Valley of New Mexico, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD2006-0509 | NM | |
| Family Medicine Physician | 207Q00000X | 52748 | MN | Yes |
Addresses
Primary practice location
2101 Elm St N
Fargo, ND 58102-2417
Mailing address
2101 Elm St N
Fargo, ND 58102-2417
Phone (701) 335-4380
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03073335 | Medicaid | NM | |
| MD2006-0509 | Other | NM | LICENSE |
| NM001P81 | Other | NM | BCBS |
| P00405998 | Other | NM | RAILROAD MEDICARE |
| 1164581625 | Medicaid | MN |
Other names
- Promil Alawadhi
Other providers in Fargo, ND
- Yani Bhattarai
- Krishna Prasad Bhetwal
- Bhsnd-PLLC
- Manjuri Bhujel
- Kaushik Bhunia
- Robert Irwin Biberdorf
- Mensura Biberovic
- Matthew Gene Bickel
- Garrett Bickett
- Ranae Bickett
All providers in Fargo, ND · Family Medicine Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 26, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.