=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558505172
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAUTAM KANU GANDHI M.D., PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2009
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 N SHACKLEFORD RD STE 108
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-234-0600
-----------------------------------------------------
Fax | 501-232-3409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17200 CHENAL PKWY STE 300-303
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72223-5958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-234-0600
-----------------------------------------------------
Fax | 501-232-3409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | E9614
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------