Provider Demographics
NPI:1477547875
Name:VAYUVEGULA, SATISH V (MD)
Entity Type:Individual
Prefix:DR
First Name:SATISH
Middle Name:V
Last Name:VAYUVEGULA
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 1:4721 HOLLAND LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4594
Mailing Address - Country:US
Mailing Address - Phone:312-718-2368
Mailing Address - Fax:
Practice Address - Street 1:4721 HOLLAND LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4594
Practice Address - Country:US
Practice Address - Phone:312-718-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106606202K00000X, 2086S0129X
OH35094576202K00000X, 207P00000X, 208D00000X
TXP2390207P00000X, 208D00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADG0518OtherMEDICARE RAILROAD GROUP PTAN
TNP00888630OtherMEDICARE RAILROAD INDIVIDUAL PTAN
MODF3698OtherMEDICARE RAILROAD GROUP PTAN
VAG01618OtherMEDICARE GROUP PTAN
IL789510OtherMEDICARE GROUP PTAN
IL789511OtherMEDICARE GROUP PTAN
TNDE5194OtherMEDICARE RAILROAD GROUP PTAN
ILP00167671OtherMEDICARE RAILROAD INDIVIDUAL PTAN
VAP00468401OtherMEDICARE RAILROAD INDIVIDUAL PTAN
ILDC4196OtherMEDICARE RAILROAD GROUP PTAN
MOP00889814OtherMEDICARE RAILROAD INDIVIDUAL PTAN
TX1477547875Medicaid
TN3733226OtherMEDICARE GROUP PTAN
PA194873OtherMEDICARE GROUP PTAN
MOW650000OtherMEDICARE GROUP PTAN
ILP00167671OtherMEDICARE RAILROAD INDIVIDUAL PTAN
H68849Medicare UPIN
TN103I936094Medicare PIN
MOP00889814OtherMEDICARE RAILROAD INDIVIDUAL PTAN
TNP00888630OtherMEDICARE RAILROAD INDIVIDUAL PTAN
TNDE5194OtherMEDICARE RAILROAD GROUP PTAN