Provider Demographics
NPI:1194003384
Name:SUBRAMANIAM, GANDHIVARMA
Entity Type:Individual
Prefix:DR
First Name:GANDHIVARMA
Middle Name:
Last Name:SUBRAMANIAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GANDHIVARMA
Other - Middle Name:
Other - Last Name:SUBRAMANIAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4001 W 105 ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4028
Mailing Address - Country:US
Mailing Address - Phone:614-735-9127
Mailing Address - Fax:
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:614-735-9127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012030144207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery