MEDICARE: KESHAVA MURTHY NARAYANA GOWDA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0203X	Pediatric Critical Care Medicine Physician	4301096275	MI
2	2080P0203X	Pediatric Critical Care Medicine Physician	35.120616	OH

General Provider Information

NPI Number	:	1003121971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KESHAVA MURTHY NARAYANA GOWDA M.D

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE # M-14
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1833
Country	:	US
Telephone Number	:	216-212-3601
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # M-14
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1833
Country	:	US
Telephone Number	:	216-212-3601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	11/19/2021

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