Provider Demographics
NPI:1427070267
Name:RAO, MATURU SATYA (MD)
Entity type:Individual
Prefix:
First Name:MATURU
Middle Name:SATYA
Last Name:RAO
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 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-3616
Mailing Address - Fax:219-364-3610
Practice Address - Street 1:2000 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2800
Practice Address - Country:US
Practice Address - Phone:219-531-9419
Practice Address - Fax:219-531-9655
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032604A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060034783OtherRAILROAD MEDICARE
IN100356570Medicaid
000000182851OtherBLUE CROSS BLUE SHIELD IN
90000561OtherBLUE SHIELD OF IL
IN659540IMedicare ID - Type UnspecifiedMEDICARE NUMBER
IN100356570Medicaid