=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518199314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NANDKISHORE R GURRAM MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2009
-----------------------------------------------------
Last Update Date | 11/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8715 VILLAGE DR SUITE 400
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-646-6556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8715 VILLAGE DR SUITE 400
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-646-6556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NANDKISHORE R GURRAM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 210-646-6556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | N3705
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------