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General NPI Number Information
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NPI Number | 1033231220
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Entity Type | Individual
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Provider Name | NANDU GOURINENI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 200 MEDICAL PKWY STE 110
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City | LAKEWAY
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State | TX
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Zip | 78738-1792
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Country | US
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Telephone | 542-724-2111
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Fax | 812-378-8267
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Provider Business Mailing Address
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Address Line | PO BOX 844658
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City | DALLAS
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State | TX
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Zip | 75284-4658
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01072691A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01072691A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 01072691A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | U8334
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License Number State | TX
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