Provider Demographics
NPI:1689671307
Name:GURAM, MANINDER SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANINDER
Middle Name:SINGH
Last Name:GURAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HOLDERRIETH BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5189
Mailing Address - Country:US
Mailing Address - Phone:281-205-7522
Mailing Address - Fax:281-205-7553
Practice Address - Street 1:425 HOLDERRIETH BLVD STE 114
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5189
Practice Address - Country:US
Practice Address - Phone:281-205-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0511207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038198001Medicaid
TX0985004Medicaid
TX890983OtherMEDICARE