Gautam Phookan
Neurosurgeon
2525 W University Ave Suite 503
Muncie
, Indiana 47303-3421
Gautam Phookan
Neurosurgeon
2525 W University Ave Suite 503
Muncie
, Indiana 47303-3421
(877) 668-5621
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About
Features
Specialties
- Neurosurgeon
Languages spoken
- English
Location
First Address
- Gautam Phookan
- 1200 W White River Blvd Ste 250
- Muncie, IN
- Zip : 47303-4988
- Phone : (877) 668-5621
Second Address
- Gautam Phookan
- 2525 W University Ave Suite 503
- Muncie, IN
- Zip : 47303-3421
- Fax : (765) 282-7879
- Phone : (765) 288-0441
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207T00000X | Neurosurgeon | 1050143 | IN |
National Provider Identifier
| NPI | 1093750978 |
|---|---|
| Provider Name | Gautam Phookan |
| First Address | Muncie, IN 47303-4988 |
| Second Address | Muncie, IN 47303-3421 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/06/2006 |
| Last Update Date | 10/02/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 200206470A | (05) | IN |
| G94993 | (02) | IN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.