Provider Demographics
NPI:1609969005
Name:KESAVARAMANUJAM, SATISH (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:
Last Name:KESAVARAMANUJAM
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 1:107 N HALL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5850
Mailing Address - Country:US
Mailing Address - Phone:559-730-2000
Mailing Address - Fax:559-730-2000
Practice Address - Street 1:107 N HALL ST
Practice Address - Street 2:SUITE B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5850
Practice Address - Country:US
Practice Address - Phone:559-730-2000
Practice Address - Fax:559-730-2000
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96658208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A966580Medicaid
CAI61605Medicare UPIN
CA00A966580Medicaid