Provider Demographics
NPI:1629099635
Name:SATISH, SHIVA (MD)
Entity Type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:SATISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-0003
Mailing Address - Country:US
Mailing Address - Phone:713-777-5334
Mailing Address - Fax:713-429-5207
Practice Address - Street 1:16605 SOUTHWEST FWY
Practice Address - Street 2:SUITE 175
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-0003
Practice Address - Country:US
Practice Address - Phone:713-777-5334
Practice Address - Fax:713-429-5207
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6232208M00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CW374OtherBCBS TX
TX8DK799OtherBCBS TX
TXP01071853OtherRR MEDICARE
TXTXB151471OtherMEDICARE
TXP00959960OtherRR MEDICARE
TXTXB130432OtherMEDICARE
TX116899904Medicaid
TX116899905OtherMEDICAID
TX116899906OtherMEDICAID
TX0657304OtherCIGNA
TX5164045OtherAETNA
TX116899905OtherMEDICAID
F77799Medicare UPIN