Provider Demographics
NPI:1811145212
Name:SAMAVEDI, SUBRAHMANYESWARA SRINIVAS (MD)
Entity type:Individual
Prefix:
First Name:SUBRAHMANYESWARA
Middle Name:SRINIVAS
Last Name:SAMAVEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2214 CANTERBURY DR STE 308
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2375
Mailing Address - Country:US
Mailing Address - Phone:785-628-6014
Mailing Address - Fax:785-628-6094
Practice Address - Street 1:2214 CANTERBURY DR STE 308
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2375
Practice Address - Country:US
Practice Address - Phone:785-628-6014
Practice Address - Fax:785-628-6094
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0440636208800000X
OH35.096110208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology