MEDICARE: YADHU GAUTAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1356288690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YADHU GAUTAM

Provider Business Mailing Address
First Line	:	336 KESTREL DR
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-8108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 KESTREL DR
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-8108
Country	:	US
Telephone Number	:	614-705-8910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ YADHU GAUTAM ” Practice Location

Language	Start Address	Practice Location

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