Provider Demographics
NPI:1154703692
Name:MALHOTRA, GAUTAM K (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GAUTAM
Middle Name:K
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:983280 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-3280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:983280 NEBRASKA MEDICAL CTR
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-3280
Practice Address - Country:US
Practice Address - Phone:402-559-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-21
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE7536208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery