Individual
DR. CHAKSHU GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3149 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70506-7209
(337) 288-5961
(337) 706-3415
Mailing address
3149 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70506-7209
(337) 288-5961
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15033R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1160164
—
LA
01
—
4F344
MEDICARE PROVIDER
—
Enumeration date
06/01/2005
Last updated
10/23/2023
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