Provider Demographics
NPI:1093712804
Name:KAMATH, SATISH N (MD)
Entity Type:Individual
Prefix:DR
First Name:SATISH
Middle Name:N
Last Name:KAMATH
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 1:5195 RECTOR CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2655
Mailing Address - Country:US
Mailing Address - Phone:248-855-6145
Mailing Address - Fax:
Practice Address - Street 1:24100 OXFORD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2481
Practice Address - Country:US
Practice Address - Phone:313-274-2500
Practice Address - Fax:313-274-7805
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-10-10
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MI037671207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108201261OtherBCBS IND
MI1108201261OtherBCN IND
MI791083861OtherRAILROAD MEDICARE
MIE21158Medicare UPIN
MI1108201261OtherBCN IND