Provider Demographics
NPI:1265277933
Name:GOWDA, HANUMAN
Entity type:Individual
Prefix:DR
First Name:HANUMAN
Middle Name:
Last Name:GOWDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12331 WATERSTONE LN APT 708
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3045
Mailing Address - Country:US
Mailing Address - Phone:443-615-2924
Mailing Address - Fax:
Practice Address - Street 1:650 STEWART RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4222
Practice Address - Country:US
Practice Address - Phone:734-240-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351053517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine