Provider Demographics
NPI:1477547149
Name:GULATI, PREM KUMAR (MD)
Entity type:Individual
Prefix:
First Name:PREM
Middle Name:KUMAR
Last Name:GULATI
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 1:1868 SPARKMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-1122
Mailing Address - Country:US
Mailing Address - Phone:256-721-9916
Mailing Address - Fax:256-721-9973
Practice Address - Street 1:1868 SPARKMAN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1122
Practice Address - Country:US
Practice Address - Phone:256-721-9916
Practice Address - Fax:256-721-9973
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00010377173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631287696OtherPROVIDER TAX ID
AL051506668Medicaid
AL009912735Medicaid
AL51509746OtherBLUE CROSS
AL631287696OtherPROVIDER TAX ID
AL009912735Medicaid
AL051506668Medicaid