Healthcare Provider Details

I. General information

NPI: 1831298553
Provider Name (Legal Business Name): ANANDAPADMANABAN GOURISHANKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL CENTER BLVD
WEBSTER TX
77598-4220
US

IV. Provider business mailing address

7008 FERRRIS STREET
BELLAIRE TX
77401
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-3381
  • Fax: 281-338-3380
Mailing address:
  • Phone: 713-660-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM2624
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: