Provider Demographics
NPI:1649469495
Name:GAITONDE, SHRAWAN GAJANAN (MD)
Entity type:Individual
Prefix:
First Name:SHRAWAN
Middle Name:GAJANAN
Last Name:GAITONDE
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-562-5999
Mailing Address - Fax:972-596-3838
Practice Address - Street 1:5236 W UNIVERSITY DR STE 1000
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-8106
Practice Address - Country:US
Practice Address - Phone:972-562-5999
Practice Address - Fax:972-596-3838
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1244102086S0127X
390200000X
TXR46992086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX377988601Medicaid