Provider Demographics
NPI:1417045311
Name:IDURU, SATISH V (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:V
Last Name:IDURU
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 1:1900 NORTH LOOP W STE 390
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8148
Mailing Address - Country:US
Mailing Address - Phone:713-694-6066
Mailing Address - Fax:713-694-6067
Practice Address - Street 1:4201 GARTH RD STE 309
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3156
Practice Address - Country:US
Practice Address - Phone:281-671-5960
Practice Address - Fax:281-970-6639
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5738207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362227602Medicaid