MEDICARE: AMIT GUTTIGOLI 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	207RC0000X	Cardiovascular Disease Physician	49721	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00243855	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8P5840	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1760417026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIT GUTTIGOLI MD

Provider Business Mailing Address
First Line	:	8144 WALNUT HILL LN STE 450
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-0906
Country	:	US
Telephone Number	:	469-513-2666
Fax Number	:	469-513-2667

Provider Business Practice Location Address
First Line	:	1018 E WHEATLAND RD
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75116-4914
Country	:	US
Telephone Number	:	469-513-2666
Fax Number	:	469-513-2667

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	12/12/2016

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Directions to “ AMIT GUTTIGOLI MD” Practice Location

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