Provider Demographics
NPI:1346504446
Name:RADHAKRISHNAN, GOWRI (MD)
Entity type:Individual
Prefix:
First Name:GOWRI
Middle Name:
Last Name:RADHAKRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 W CHARLESTON BLVD STE 300
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2244
Mailing Address - Country:US
Mailing Address - Phone:702-671-2345
Mailing Address - Fax:702-671-2376
Practice Address - Street 1:2040 W CHARLESTON BLVD STE 300
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2244
Practice Address - Country:US
Practice Address - Phone:702-671-2345
Practice Address - Fax:702-671-2376
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV15820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program