Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 01058659 | IN |
Y | 2080P0203X | Pediatric Critical Care Doctor | N7782 | TX |
NPI | 1023127131 |
---|---|
Provider Name | Gokul K Bysani |
First Address | Dallas, TX 75230-6903 |
Second Address | Dallas, TX 75230-6903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 30/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036069391 | (05) | IL |
1023127131 | (05) | MI |
1800155 | (05) | LA |
200288950 | (05) | IN |
206300303 | (05) | MO |
217979801 | (05) | TX |
E18623 | (02) |