Provider Demographics
NPI:1982704599
Name:KATTA, RAJANI (MD)
Entity Type:Individual
Prefix:
First Name:RAJANI
Middle Name:
Last Name:KATTA
Suffix:
Gender:F
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:PO BOX 4788
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4788
Mailing Address - Country:US
Mailing Address - Phone:713-798-6131
Mailing Address - Fax:713-798-6923
Practice Address - Street 1:1977 BUTLER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:713-798-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6037207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103624601Medicaid
TX103624602Medicaid
88H388Medicare PIN
070012166Medicare PIN
TX103624602Medicaid
TX103624601Medicaid
83515FMedicare PIN
070013270Medicare PIN