Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 43864 | TN |
N | 2086S0120X | Pediatric Surgery | 54986-20 | WI |
NPI | 1104047083 |
---|---|
Provider Name | Ankush Gosain |
First Address | Memphis, TN 38105-4625 |
Second Address | Memphis, TN 38105-4625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 02/05/2016 |