Provider Demographics
NPI:1396850954
Name:SUDHEER R KARNATI MD PA
Entity Type:Organization
Organization Name:SUDHEER R KARNATI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUDHEER
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:KARNATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-634-1003
Mailing Address - Street 1:5 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3173
Mailing Address - Country:US
Mailing Address - Phone:936-632-5529
Mailing Address - Fax:936-634-1003
Practice Address - Street 1:5 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3173
Practice Address - Country:US
Practice Address - Phone:936-632-5529
Practice Address - Fax:936-634-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149215901Medicaid
G80540Medicare UPIN
TX00829RMedicare ID - Type Unspecified