MEDICARE: SATISH CHANDRAPRAKASAM 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	207R00000X	Internal Medicine Physician	2009012445	MO
2	207RC0000X	Cardiovascular Disease Physician	6714	NE
3	207RC0000X	Cardiovascular Disease Physician	Q7340	TX
4	207RI0011X	Interventional Cardiology Physician	Q7340	TX

General Provider Information

NPI Number	:	1235369695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SATISH CHANDRAPRAKASAM M.D.

Provider Business Mailing Address
First Line	:	5801 OAKBEND TRL STE 270
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3922
Country	:	US
Telephone Number	:	817-882-6868
Fax Number	:	817-439-9115

Provider Business Practice Location Address
First Line	:	5801 OAKBEND TRL STE 270
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3922
Country	:	US
Telephone Number	:	817-882-6868
Fax Number	:	817-439-9115

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

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	04/21/2023

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