Individual
NISCHAL KRISHNAMURTHY GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6411 FANNIN ST DEPT OF, HOUSTON, TX 77030-1501
(713) 500-6222
(713) 500-6208
Mailing address
28 WINTERFERN COVE, LITTLE ROCK, AR 72211
(501) 219-1074
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
E-4917
AR
207LP3000X
Pediatric Anesthesiology Physician
Primary
N9372
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163818001
—
AR
01
—
P00402663
RAILROAD MEDICARE
—
Enumeration date
12/18/2006
Last updated
02/24/2023
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