Provider Demographics
NPI:1275979189
Name:SATYANARAYANA, BHAVANI MYSORE (MD)
Entity Type:Individual
Prefix:
First Name:BHAVANI
Middle Name:MYSORE
Last Name:SATYANARAYANA
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 1:11803 SOUTH FWY
Mailing Address - Street 2:STE 103
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7012
Mailing Address - Country:US
Mailing Address - Phone:817-293-9552
Mailing Address - Fax:817-551-5080
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:STE 103
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7012
Practice Address - Country:US
Practice Address - Phone:817-293-9552
Practice Address - Fax:817-551-5080
Is Sole Proprietor?:No
Enumeration Date:2013-05-18
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1185208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice