MEDICARE: DR. MANJULATHA BADAM MD

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	M7480	TX
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	M7480	TX

General Provider Information

NPI Number	:	1417013368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANJULATHA BADAM MD

Provider Business Mailing Address
First Line	:	13423 BLANCO RD # 767
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2187
Country	:	US
Telephone Number	:	210-651-1112
Fax Number	:	855-479-2049

Provider Business Practice Location Address
First Line	:	8666 HUEBNER RD STE 220
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1837
Country	:	US
Telephone Number	:	210-951-9981
Fax Number	:

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	11/12/2021

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