Provider Demographics
NPI:1790704633
Name:PALIKH, GAURANG MANILAL (MD)
Entity Type:Individual
Prefix:
First Name:GAURANG
Middle Name:MANILAL
Last Name:PALIKH
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:PO BOX 1502
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-1502
Mailing Address - Country:US
Mailing Address - Phone:704-730-8461
Mailing Address - Fax:704-730-8349
Practice Address - Street 1:407 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3345
Practice Address - Country:US
Practice Address - Phone:704-730-8461
Practice Address - Fax:704-730-8349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL29193207R00000X
NC1411672084N0400X
NC2009-017612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1790704633Medicaid
NC5916921Medicaid
SCNC1254Medicaid
NC76392UMedicare UPIN
NC5916921Medicaid
NCNC1150BMedicare PIN