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General NPI Number Information
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NPI Number | 1760410823
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Entity Type | Individual
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Provider Name | GOPIKRISHNAN VASUDEVAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 816 22ND AVE SUITE 100
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City | KEARNEY
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State | NE
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Zip | 68845-2206
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Country | US
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Telephone | 308-865-2263
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Fax | 308-865-2541
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Provider Business Mailing Address
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Address Line | 816 22ND AVE SUITE 100
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City | KEARNEY
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State | NE
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Zip | 68845-2206
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Country | US
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Telephone | 308-865-2263
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Fax | 308-865-2541
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 31491
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License Number State | NE
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