Healthcare Provider Details

I. General information

NPI: 1073185807
Provider Name (Legal Business Name): TEJAS GOWDA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W HIGH ST STE 201
LIMA OH
45801-3969
US

IV. Provider business mailing address

830 W HIGH ST STE 201
LIMA OH
45801-3969
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5046
  • Fax: 419-996-5005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number34.018697
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: