Healthcare Provider Details

I. General information

NPI: 1417045311
Provider Name (Legal Business Name): SATISH V IDURU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 GARTH RD STE 309
BAYTOWN TX
77521-3156
US

IV. Provider business mailing address

1900 NORTH LOOP W STE 390
HOUSTON TX
77018-8148
US

V. Phone/Fax

Practice location:
  • Phone: 281-671-5960
  • Fax: 281-970-6639
Mailing address:
  • Phone: 713-694-6066
  • Fax: 713-694-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number152373
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN5738
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: