Individual
GAUTAMI GANDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1145 S UTICA AVE, TULSA, OK 74104-4000
(918) 579-2367
Mailing address
1145 S UTICA AVE STE 600, TULSA, OK 74104-4070
(918) 579-2367
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
T3952
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2019
Last updated
06/24/2022
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