Healthcare Provider Details

I. General information

NPI: 1073317111
Provider Name (Legal Business Name): KARTHIK V MADHIRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. SAI KARTHIK V MADHIRA

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E 29TH ST STE 100
BRYAN TX
77802-2623
US

IV. Provider business mailing address

1 HEROES WAY
RIVERHEAD NY
11901-2054
US

V. Phone/Fax

Practice location:
  • Phone: 979-436-0485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: