MEDICARE: DR. MOHANAKRISHNAN SATHYAMOORTHY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	N2777	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134233588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHANAKRISHNAN SATHYAMOORTHY M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-423-8585
Fax Number	:	817-423-8458

Provider Business Practice Location Address
First Line	:	1121 5TH AVE STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4386
Country	:	US
Telephone Number	:	817-423-8585
Fax Number	:	817-423-8458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	02/04/2020

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