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NPI Code Detail

MEDICARE: DR. CHAKSHU GAUTAM M.D.

MEDICARE: DR. CHAKSHU GAUTAM 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
1207Q00000XFamily Medicine Physician15033RLA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
24F344OTHERMEDICARE PROVIDER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952303240
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAKSHU GAUTAM M.D.
Provider Business Mailing Address
First Line : 3149 AMBASSADOR CAFFERY PKWY
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-7209
Country : US
Telephone Number : 337-288-5961
Fax Number :
Provider Business Practice Location Address
First Line : 3149 AMBASSADOR CAFFERY PKWY
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-7209
Country : US
Telephone Number : 337-288-5961
Fax Number : 337-706-3415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 10/23/2023

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