MEDICARE: DR. HIMABINDU BANDARU 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	207R00000X	Internal Medicine Physician	084792	OH

General Provider Information

NPI Number	:	1871675942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIMABINDU BANDARU MD

Provider Business Mailing Address
First Line	:	18111 MUIR GLEN DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-5064
Country	:	US
Telephone Number	:	937-427-7989
Fax Number	:

Provider Business Practice Location Address
First Line	:	4522 FREDERICKSBURG RD
Second Line	:	SUITE A10
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6521
Country	:	US
Telephone Number	:	614-257-5741
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/05/2016

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