Healthcare Provider Details

I. General information

NPI: 1215053731
Provider Name (Legal Business Name): MOHAN S GULATI, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PGA BLVD STE 130
PALM BEACH GARDENS FL
33410-3515
US

IV. Provider business mailing address

5484 SEA BISCUIT RD
PALM BEACH GARDENS FL
33418-7811
US

V. Phone/Fax

Practice location:
  • Phone: 561-641-8787
  • Fax: 561-919-9108
Mailing address:
  • Phone: 561-641-8787
  • Fax: 561-919-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME69967
License Number StateFL

VIII. Authorized Official

Name: MOHAN S GULATI
Title or Position: MD
Credential:
Phone: 561-641-8787