Provider Demographics
NPI:1922110113
Name:MADHU, PURUSHOTHAMAN (MD)
Entity type:Individual
Prefix:DR
First Name:PURUSHOTHAMAN
Middle Name:
Last Name:MADHU
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 1:7319 GENTLE WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0145
Mailing Address - Country:US
Mailing Address - Phone:346-515-7282
Mailing Address - Fax:
Practice Address - Street 1:1265 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4541
Practice Address - Country:US
Practice Address - Phone:931-363-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0935207PP0204X, 208000000X
TXFTL42125208000000X
GA051976208000000X
NY295558208000000X
TN69971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA916968941CMedicaid
H82806Medicare UPIN
GA916968941CMedicaid
GA916968941CMedicaid