Provider Demographics
NPI:1760427173
Name:KORTIKERE, SARITHA ARUN (MD)
Entity Type:Individual
Prefix:
First Name:SARITHA
Middle Name:ARUN
Last Name:KORTIKERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5130
Mailing Address - Country:US
Mailing Address - Phone:903-232-8100
Mailing Address - Fax:903-232-8115
Practice Address - Street 1:805 MEDICAL CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605
Practice Address - Country:US
Practice Address - Phone:903-232-8100
Practice Address - Fax:903-232-8115
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMI431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175875709Medicaid
TXTXB147404Medicare PIN
I39265Medicare UPIN