Provider Demographics
NPI:1699835777
Name:SACRAMENTO GASTROENTEROLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SACRAMENTO GASTROENTEROLOGY MEDICAL GROUP, INC.
Other - Org Name:SACRAMENTO GASTROENTEROLOGY MEDICAL GROUP, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAUTAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-454-0655
Mailing Address - Street 1:3941 J STREET
Mailing Address - Street 2:SUITE #450
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819
Mailing Address - Country:US
Mailing Address - Phone:916-454-0655
Mailing Address - Fax:916-454-5702
Practice Address - Street 1:3941 J STREET
Practice Address - Street 2:SUITE #450
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-454-0655
Practice Address - Fax:916-454-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E99052Medicare UPIN
A26602Medicare UPIN
H39417Medicare UPIN
A29310Medicare UPIN
A59073Medicare UPIN