Provider Demographics
NPI:1356409437
Name:ABBURI, MADHAVA SETHU (MD)
Entity type:Individual
Prefix:
First Name:MADHAVA
Middle Name:SETHU
Last Name:ABBURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7000 NORTH MOPAC
Mailing Address - Street 2:SUITE # 420
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-482-0045
Mailing Address - Fax:512-476-9892
Practice Address - Street 1:7000 NORTH MOPAC
Practice Address - Street 2:SUITE # 420
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-482-0045
Practice Address - Fax:512-476-9892
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALSP-158207R00000X
KY36303207R00000X
WI43784020207R00000X
TXN3412207R00000X
ARE-12394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34199000Medicaid
TX209626501Medicaid
TX209626502Medicaid
H55939Medicare UPIN
TX209626502Medicaid
TXP00825483Medicare PIN
TX209626501Medicaid
TX8L24363Medicare PIN