Provider Demographics
NPI:1831100676
Name:GOLI, SADASIVAREDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:SADASIVAREDDY
Middle Name:
Last Name:GOLI
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:PO BOX 38252
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77238-8252
Mailing Address - Country:US
Mailing Address - Phone:713-695-8180
Mailing Address - Fax:713-695-8195
Practice Address - Street 1:5990 AIRLINE DR
Practice Address - Street 2:250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4237
Practice Address - Country:US
Practice Address - Phone:713-695-8180
Practice Address - Fax:713-695-8195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL3314OtherLICENSE
TXBG17600667OtherDEA
TXL3314OtherLICENSE