Provider Demographics
NPI:1699830901
Name:SHREENIVAS, SATYA SANATAN (MD)
Entity Type:Individual
Prefix:
First Name:SATYA
Middle Name:SANATAN
Last Name:SHREENIVAS
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 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO 2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-206-1060
Mailing Address - Fax:513-206-1062
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SU. 136
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-206-1060
Practice Address - Fax:513-206-1062
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435353207RC0000X
OH35124124207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102470760Medicaid
KY7100322380Medicaid
OH0113176Medicaid
PA186560GT6Medicare PIN
OH0113176Medicaid