Basic Information
Provider Information | |||||||||
NPI: | 1275724585 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AGADI | ||||||||
FirstName: | SATISH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 650859 | ||||||||
Address2: | DEPT 710 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752653901 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4097476240 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 301 UNIVERSITY BLVD | ||||||||
Address2: |   | ||||||||
City: | GALVESTON | ||||||||
State: | TX | ||||||||
PostalCode: | 775554402 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4097721594 | ||||||||
FaxNumber: | 4073038197 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/05/2007 | ||||||||
LastUpdateDate: | 07/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0600X | N2358 | TX | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | 2084N0402X | N2358 | TX | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
ID | Type | State | Issuer | Description | 214849613 | 05 | TX |   | MEDICAID | 214849611 | 05 | TX |   | MEDICAID | P01464127 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 8FA081 | 01 | TX | BCBS | OTHER | 75-2616977-052 | 01 | TX | TRICARE | OTHER |