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NPI Code Detail

MEDICARE: KRANTHI KUMAR GOURAVARAM DO

MEDICARE: KRANTHI KUMAR GOURAVARAM DO
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
1207P00000XEmergency Medicine PhysicianDO3517ME

General Provider Information

NPI Number : 1629538244
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRANTHI KUMAR GOURAVARAM DO
Provider Business Mailing Address
First Line : 150 4TH AVE APT PH1
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-4557
Country : US
Telephone Number : 925-984-0235
Fax Number :
Provider Business Practice Location Address
First Line : 4422 3RD AVE
Second Line :
City : BRONX
State : NY
Zip : 10457-2545
Country : US
Telephone Number : 718-960-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 02/02/2026

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