Provider Demographics
NPI:1982707071
Name:SUBBANNA, SATHYASHANKAR (MD)
Entity Type:Individual
Prefix:
First Name:SATHYASHANKAR
Middle Name:
Last Name:SUBBANNA
Suffix:
Gender:M
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 1588
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66505-1588
Mailing Address - Country:US
Mailing Address - Phone:785-537-9349
Mailing Address - Fax:785-537-9486
Practice Address - Street 1:1133 COLLEGE AVE BLDG B
Practice Address - Street 2:#224
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-537-9349
Practice Address - Fax:785-537-9486
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04303062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH69983Medicare UPIN
KS105117Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE