MEDICARE: SATISH KUMAR BANKURU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	0101236668	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750331732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SATISH KUMAR BANKURU MD

Provider Business Mailing Address
First Line	:	3601 BOULVARD
Second Line	:	SUITE C
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1338
Country	:	US
Telephone Number	:	804-504-0068
Fax Number	:	804-504-0080

Provider Business Practice Location Address
First Line	:	3601 BOULVARD
Second Line	:	SUITE C
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1338
Country	:	US
Telephone Number	:	804-504-0068
Fax Number	:	804-504-0080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	06/24/2015

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