Provider Demographics
NPI:1336219377
Name:DR. SESHA K. SATALURI, MD, LLC
Entity Type:Organization
Organization Name:DR. SESHA K. SATALURI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SESHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SATALURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-212-0412
Mailing Address - Street 1:1801 FAIRFIELD AVE., SUITE 304
Mailing Address - Street 2:SESHA K. SATALURI, MD, LLC
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-212-0412
Mailing Address - Fax:318-212-0416
Practice Address - Street 1:1801 FAIRFIELD AVE., SUITE 304
Practice Address - Street 2:SESHA K. SATALURI, MD, LLC
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-212-0412
Practice Address - Fax:318-212-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1099597Medicaid
LA1099597Medicaid
LA5CW09Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER