Provider Demographics
NPI:1285816827
Name:POTLURI, SATISH B (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:B
Last Name:POTLURI
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-5621
Practice Address - Country:US
Practice Address - Phone:512-571-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432507207R00000X, 208M00000X
TXN5340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020436720003Medicaid
PA1998135OtherHIGHMARK BLUE SHIELD
TX314152501Medicaid
TX314152504Medicaid
TX314152502Medicaid
PA1020436720002Medicaid
PA30048106OtherKEYSTONE MERCY
TX314152503Medicaid
PA1020436720001Medicaid
PA1747437OtherAETNA GRP #
PA2858549000OtherKEYSTONE IBC GRP #
PA39159OtherHEALTH PARTNERS
PA2858549000OtherKEYSTONE IBC GRP #
PA1020436720003Medicaid
TX264877YLP2Medicare PIN
PA30048106OtherKEYSTONE MERCY
PA1020436720001Medicaid
TX314152504Medicaid
TXP01379407Medicare PIN