MEDICARE: MANJIT SINGH GULATI 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	207RN0300X	Nephrology Physician	ME 75667	FL

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

General Provider Information

NPI Number	:	1164433256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANJIT SINGH GULATI MD

Provider Business Mailing Address
First Line	:	10726 CHARLESTON PL
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-4906
Country	:	US
Telephone Number	:	954-438-6080
Fax Number	:	954-499-5599

Provider Business Practice Location Address
First Line	:	3105 N UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33024-2234
Country	:	US
Telephone Number	:	954-438-6080
Fax Number	:	954-499-5599

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	02/01/2013

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