MEDICARE: GUT ANESTHESIA CARE ASSOCIATES LLC

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	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1750986501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUT ANESTHESIA CARE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	9330 LBJ FWY STE 800
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-4310
Country	:	US
Telephone Number	:	972-792-5700
Fax Number	:	888-510-3225

Provider Business Practice Location Address
First Line	:	15300 SOUTHWEST FWY STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3827
Country	:	US
Telephone Number	:	855-677-8669
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MADHUKAR KAW
Credential	:	MD
Telephone Number	:	713-302-4813

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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