Individual
DR. NANDU GOURINENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 MEDICAL PKWY STE 110, LAKEWAY, TX 78738-1792
(542) 724-2111
(812) 378-8267
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01072691A
IN
207RC0000X
Cardiovascular Disease Physician
01072691A
IN
207RI0011X
Interventional Cardiology Physician
01072691A
IN
207RI0011X
Interventional Cardiology Physician
Primary
U8334
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000990789
ANTHEM PIN
IN
05
—
201175570
—
IN
Enumeration date
04/06/2007
Last updated
09/06/2024
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