Healthcare Provider Details

I. General information

NPI: 1043507908
Provider Name (Legal Business Name): KARTIKE GULATI D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MAIN ST STE 1A
HIGHLAND IN
46322-3514
US

IV. Provider business mailing address

2211 MAIN ST STE 1A
HIGHLAND IN
46322-3514
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-9368
  • Fax: 219-836-9357
Mailing address:
  • Phone: 219-836-9368
  • Fax: 219-836-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number60218
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number02005425A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: