Organization
MICKY GAUTAM, D.O., P.A.
Active
Organization
MICKY GAUTAM, D.O., P.A.
Active
Other names
Psych Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICKY KEYURNATH GAUTAM D.O. (OWNER/PRESIDENT)
(214) 223-9235
Entity
Organization
Contact information
Practice address
800 KIRNWOOD DR, DESOTO, TX 75115-2000
(214) 223-9235
Mailing address
PO BOX 561136, THE COLONY, TX 75056-6136
(214) 223-9235
(817) 730-9080
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
L1861
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L1861
TX LICENSE
TX
Enumeration date
12/19/2008
Last updated
08/13/2026
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