MEDICARE: MUKUND I GUNDANNA 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	207X00000X	Orthopaedic Surgery Physician	L8709	TX
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	L8709	TX

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	:	1730156811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKUND I GUNDANNA MD

Provider Business Mailing Address
First Line	:	3526 LONGMIRE DR
Second Line	:	STE 101
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-6473
Country	:	US
Telephone Number	:	979-693-1815
Fax Number	:	979-693-4706

Provider Business Practice Location Address
First Line	:	1602 ROCK PRAIRIE RD
Second Line	:	SUITE 2400
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8306
Country	:	US
Telephone Number	:	979-693-1815
Fax Number	:	979-693-4706

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/25/2018

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Directions to “ MUKUND I GUNDANNA MD” Practice Location

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