MEDICARE: T. GOPAL & ASSOCIATES, M.D., P.A.

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	207R00000X	Internal Medicine Physician	K5966	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00506U	OTHER	TX	GROUP MC #T GOPAL & ASSOC
2	I04507	OTHER	TX	MC UPIN DR. BALASUBRAMANI

General Provider Information

NPI Number	:	1316154073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T. GOPAL & ASSOCIATES, M.D., P.A.

Provider Business Mailing Address
First Line	:	10594 FUQUA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-1402
Country	:	US
Telephone Number	:	281-484-3500
Fax Number	:	281-484-3517

Provider Business Practice Location Address
First Line	:	10594 FUQUA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-1402
Country	:	US
Telephone Number	:	281-484-3500
Fax Number	:	281-484-3517

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THANDAVARAJAN GOPALAKRISHNAN
Credential	:	M.D.
Telephone Number	:	281-484-3500

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/26/2007

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