Provider Demographics
NPI:1780885517
Name:SHETTI, MADHU B (MD)
Entity type:Individual
Prefix:
First Name:MADHU
Middle Name:B
Last Name:SHETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADHU
Other - Middle Name:B
Other - Last Name:BATTU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:54 STALYBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 VALE RD
Practice Address - Street 2:DOCTORS MEDICAL CENTER - CANCER CENTER
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3808
Practice Address - Country:US
Practice Address - Phone:313-871-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087455207R00000X
CAA1147332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine