Provider Demographics
NPI:1023127131
Name:BYSANI, GOKUL K (MD)
Entity type:Individual
Prefix:
First Name:GOKUL
Middle Name:K
Last Name:BYSANI
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 1:7777 FOREST LN STE D569
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6903
Mailing Address - Country:US
Mailing Address - Phone:972-566-8340
Mailing Address - Fax:972-566-8338
Practice Address - Street 1:7777 FOREST LN STE D569
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6903
Practice Address - Country:US
Practice Address - Phone:972-566-8340
Practice Address - Fax:972-566-8338
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058659207LC0200X, 2080P0203X
TXN77822080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1023127131Medicaid
TX217979801Medicaid
IL036069391Medicaid
LA1800155Medicaid
IN200288950Medicaid
MO206300303Medicaid
MO206300303Medicaid
IL036069391Medicaid