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General NPI Number Information
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NPI Number | 1164593208
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Entity Type | Individual
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Provider Name | SATYA SRINIVAS GORTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 08/17/2009
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Provider Practice Location Address
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Address Line | 855 MANKATO AVE
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City | WINONA
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State | MN
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Zip | 55987-4868
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Country | US
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Telephone | 507-457-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 301 NORTHERN HILLS DR
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City | SAINT CHARLES
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State | MN
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Zip | 55972-1394
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Country | US
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Telephone | 507-932-8153
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 48173-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 49990
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License Number State | MN
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