Provider Demographics
NPI:1164452850
Name:GARIMELLA, SATYA V (MD)
Entity Type:Individual
Prefix:
First Name:SATYA
Middle Name:V
Last Name:GARIMELLA
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:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:812-949-5482
Mailing Address - Fax:812-949-5966
Practice Address - Street 1:41 QUATERMASTER COURT
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3623
Practice Address - Country:US
Practice Address - Phone:812-282-1617
Practice Address - Fax:812-288-7625
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33516207RC0000X
IN01062841A207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200839060Medicaid
KY64016082Medicaid
INM54226080Medicare PIN
KYH24941Medicare UPIN
KY64016082Medicaid
KY0763901Medicare ID - Type Unspecified
KYP00342894OtherRAILROAD MEDICARE
IN200839060Medicaid
KYP400020962Medicare PIN
KY00181001Medicare ID - Type UnspecifiedCARROLLTON
KY2774851000OtherPASSPORT ADVANTAGE
KY7093186OtherAETNA
KY64016082Medicaid
IN077732OtherSIHO
KYH24941Medicare UPIN
KY0874908Medicare ID - Type Unspecified
IN084820HMedicare ID - Type Unspecified