Provider Demographics
NPI:1831100015
Name:VELAGAPUDI, SATISH RC (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:RC
Last Name:VELAGAPUDI
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11141 PARKVIEW PLAZA DR STE 320
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1714
Practice Address - Country:US
Practice Address - Phone:260-482-8681
Practice Address - Fax:260-969-0350
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10158261A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00790186OtherR.R. MEDICARE
IN000000633583OtherANTHEM
IN200383970Medicaid
IN200396550Medicaid
INP00071958Medicare PIN
IN264090DMedicare PIN
IN048010Medicare ID - Type Unspecified
IN200383970Medicaid