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General NPI Number Information
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NPI Number | 1811145212
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Entity Type | Individual
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Provider Name | SUBRAHMANYESWARA SRINIVAS SAMAVEDI MD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2214 CANTERBURY DR STE 308
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City | HAYS
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State | KS
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Zip | 67601-2375
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Country | US
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Telephone | 785-628-6014
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Fax | 785-628-6094
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Provider Business Mailing Address
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Address Line | 2214 CANTERBURY DR STE 308
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City | HAYS
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State | KS
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Zip | 67601-2375
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Country | US
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Telephone | 785-628-6014
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Fax | 785-628-6094
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0440636
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35.096110
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License Number State | OH
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