Provider Demographics
NPI:1356383152
Name:BANDHAKAVI, SUBHADRA (MD)
Entity type:Individual
Prefix:DR
First Name:SUBHADRA
Middle Name:
Last Name:BANDHAKAVI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 FUQUA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4541
Mailing Address - Country:US
Mailing Address - Phone:281-484-3500
Mailing Address - Fax:281-484-3517
Practice Address - Street 1:11721 FUQUA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4541
Practice Address - Country:US
Practice Address - Phone:281-484-3500
Practice Address - Fax:281-484-3517
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255368207R00000X
TXL4860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8A1986Medicare PIN
TXH76010Medicare UPIN