Provider Demographics
NPI:1407180623
Name:GURJALA, ANANDEV N (MD, MS)
Entity Type:Individual
Prefix:
First Name:ANANDEV
Middle Name:N
Last Name:GURJALA
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 THAIN WAY
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3928
Mailing Address - Country:US
Mailing Address - Phone:312-543-6970
Mailing Address - Fax:
Practice Address - Street 1:4144 THAIN WAY
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3928
Practice Address - Country:US
Practice Address - Phone:312-543-6970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125047851208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery