MEDICARE: PREM KUMAR GULATI 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	173000000X	Legal Medicine	00010377	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	631287696	OTHER	AL	PROVIDER TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	51509746	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1477547149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREM KUMAR GULATI M.D.

Provider Business Mailing Address
First Line	:	1868 SPARKMAN DR NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35816-1122
Country	:	US
Telephone Number	:	256-721-9916
Fax Number	:	256-721-9973

Provider Business Practice Location Address
First Line	:	1868 SPARKMAN DR NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35816-1122
Country	:	US
Telephone Number	:	256-721-9916
Fax Number	:	256-721-9973

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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