Healthcare Provider Details

I. General information

NPI: 1669553178
Provider Name (Legal Business Name): SATESH KUMAR RAJU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 PONCE DE LEON BLVD KIDZ MEDICAL SERVICES, INC
CORAL GABLES FL
33146
US

IV. Provider business mailing address

333 N SANTA ROSA
SAN ANTONIO TX
78207-3108
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-1515
  • Fax:
Mailing address:
  • Phone: 210-704-4100
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ8778
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ8778
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberTRN8815
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME99117
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberQ8778
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberQ8778
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: