Healthcare Provider Details

I. General information

NPI: 1477547149
Provider Name (Legal Business Name): PREM KUMAR GULATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 SPARKMAN DR NW
HUNTSVILLE AL
35816-1122
US

IV. Provider business mailing address

1868 SPARKMAN DR NW
HUNTSVILLE AL
35816-1122
US

V. Phone/Fax

Practice location:
  • Phone: 256-721-9916
  • Fax: 256-721-9973
Mailing address:
  • Phone: 256-721-9916
  • Fax: 256-721-9973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number00010377
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: