MEDICARE: GUNDUMALLA S GOUD 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	207R00000X	Internal Medicine Physician	35044133	OH

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	:	1356347876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUNDUMALLA S GOUD M.D.

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	THIRD FL
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:	216-692-1144
Fax Number	:	216-201-4536

Provider Business Practice Location Address
First Line	:	7500 AUBURN RD # 2300
Second Line	:
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9176
Country	:	US
Telephone Number	:	440-350-7444
Fax Number	:	440-350-7440

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	09/09/2015

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