Basic Information
| Provider Information | |||||||||
| NPI: | 1104047083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOSAIN | ||||||||
| FirstName: | ANKUSH | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 N DUNLAP ST | ||||||||
| Address2: | G145 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381054625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012875594 | ||||||||
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| Practice Location | |||||||||
| Address1: | 51 N DUNLAP ST | ||||||||
| Address2: | STE. 235 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381054625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012875437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 05/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | 54986-20 | WI | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 43864 | TN | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
No ID Information.