Provider Demographics
NPI:1548413230
Name:NANJUNDE GOWDA, MADAN KUMAR
Entity Type:Individual
Prefix:
First Name:MADAN KUMAR
Middle Name:
Last Name:NANJUNDE GOWDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MADAN
Other - Middle Name:
Other - Last Name:GOWDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-3880
Mailing Address - Fax:
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-3880
Practice Address - Fax:256-265-3886
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38529207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology