Healthcare Provider Details

I. General information

NPI: 1538113733
Provider Name (Legal Business Name): GAUTAM MALKANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

500 MEDICAL CENTER BLVD
WEBSTER TX
77598-4220
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-3695
  • Fax: 409-772-3680
Mailing address:
  • Phone: 281-554-4300
  • Fax: 281-554-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26579
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number26579
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberM8155
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: