Individual
DR. KANEKAL SURESH GAUTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS, MD, DM, MS
Contact information
Practice address
6410 FANNIN ST STE 470, HOUSTON, TX 77030-3008
(713) 500-5736
Mailing address
6410 FANNIN ST STE 470, HOUSTON, TX 77030-3008
(713) 500-5736
(713) 500-0653
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
ME150626
FL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
Q2855
TX
2080N0001X
Neonatal-Perinatal Medicine Physician
TL26586
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110863200
—
FL
05
—
Q09841
—
SC
Enumeration date
08/29/2006
Last updated
02/13/2025
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