Basic Information
| Provider Information | |||||||||
| NPI: | 1518993997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHADRIRAJU | ||||||||
| FirstName: | SATISH | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 S YALE AVE STE 1200 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184886687 | ||||||||
| FaxNumber: | 9184886098 | ||||||||
| Practice Location | |||||||||
| Address1: | 6585 S YALE AVE STE 650 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741368319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185025600 | ||||||||
| FaxNumber: | 9185025603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | 31260 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207R00000X | P6143 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 60351 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 31260 | OK | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 13924 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01296600 (MDACC) | 01 | TX | RR MEDICARE | OTHER | 8EE282 | 01 | TX | BCBS (MDACC) | OTHER | 334834401 (MDACC) | 05 | TX | MEDICAID |