# DR. KANEKAL SURESH GAUTHAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1972611911
- **Gender:** Man
- **Credential:** MBBS, MD, DM, MS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | ME150626 | FL | — |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | Q2855 | TX | Yes |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | TL26586 | SC | — |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 02/13/2025