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1003998840

NPI Code Detail

MEDICARE: DR. KANAKADURGA GOVINDARAJU MD

MEDICARE: DR. KANAKADURGA GOVINDARAJU MD

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	207Q00000X	Family Medicine Physician	4301065815	MI
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	L3318	TX
3	207Q00000X	Family Medicine Physician	L3318	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	106362	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003998840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KANAKADURGA GOVINDARAJU MD

Provider Business Mailing Address
First Line	:	4107 SPICEWOOD SPRINGS RD STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8645
Country	:	US
Telephone Number	:	512-397-3360
Fax Number	:	512-343-7107

Provider Business Practice Location Address
First Line	:	4107 SPICEWOOD SPRINGS RD STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8645
Country	:	US
Telephone Number	:	512-397-3360
Fax Number	:	512-343-7107

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/19/2023

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Directions to “ DR. KANAKADURGA GOVINDARAJU MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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