Provider Demographics
NPI:1841428752
Name:KATTA, SRINIVAS MAHESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SRINIVAS MAHESH
Middle Name:
Last Name:KATTA
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 1:2505 BACON CT
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1662
Mailing Address - Country:US
Mailing Address - Phone:732-986-1758
Mailing Address - Fax:888-383-0122
Practice Address - Street 1:3501 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2138
Practice Address - Country:US
Practice Address - Phone:918-913-9408
Practice Address - Fax:888-383-0122
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK30949207R00000X, 207RN0300X
WAMD61441562207R00000X
MO2012011844207RN0300X
MO2020041626208M00000X
NE27938208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200566560AMedicaid