Provider Demographics
NPI:1487673679
Name:KARANAM, SAMBASIVARAO VENKATA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMBASIVARAO
Middle Name:VENKATA
Last Name:KARANAM
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 1166
Mailing Address - Street 2:827 E. WATER STREET # B
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-1166
Mailing Address - Country:US
Mailing Address - Phone:425-766-1614
Mailing Address - Fax:
Practice Address - Street 1:827 E. WATER ST.,
Practice Address - Street 2:# B
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586-1166
Practice Address - Country:US
Practice Address - Phone:425-766-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021462208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7105240Medicaid
H13885Medicare UPIN
G8851453Medicare ID - Type UnspecifiedORG
WA7105240Medicaid