MEDICARE: DR. PURUSHOTHAMAN MADHU MD

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	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	N0935	TX
2	208000000X	Pediatrics Physician	FTL42125	TX
3	208000000X	Pediatrics Physician	051976	GA
4	208000000X	Pediatrics Physician	N0935	TX
5	208000000X	Pediatrics Physician	295558	NY
6	208000000X	Pediatrics Physician	69971	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922110113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PURUSHOTHAMAN MADHU MD

Provider Business Mailing Address
First Line	:	7319 GENTLE WILLOW LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0145
Country	:	US
Telephone Number	:	346-515-7282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1265 E COLLEGE ST
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-4541
Country	:	US
Telephone Number	:	931-363-7531
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/12/2025

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Directions to “ DR. PURUSHOTHAMAN MADHU MD” Practice Location

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