Provider Demographics
NPI:1154376051
Name:SATYANARAYANA, MADAPURA (MD)
Entity type:Individual
Prefix:DR
First Name:MADAPURA
Middle Name:
Last Name:SATYANARAYANA
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 1:11803 SOUTH FWY STE 103
Mailing Address - Street 2:BOX 6426
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7028
Mailing Address - Country:US
Mailing Address - Phone:817-293-9552
Mailing Address - Fax:817-551-5080
Practice Address - Street 1:11803 SOUTH FWY STE 103
Practice Address - Street 2:BOX 6426
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7028
Practice Address - Country:US
Practice Address - Phone:817-293-9552
Practice Address - Fax:817-551-5080
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2903208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111569301Medicaid
TX111569302Medicaid