Provider Demographics
NPI:1245298066
Name:TATINENI, SATYAM (MD)
Entity type:Individual
Prefix:DR
First Name:SATYAM
Middle Name:
Last Name:TATINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1230
Mailing Address - Country:US
Mailing Address - Phone:812-450-7899
Mailing Address - Fax:812-450-6029
Practice Address - Street 1:600 MARY STREET
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47747-0001
Practice Address - Country:US
Practice Address - Phone:812-450-7899
Practice Address - Fax:812-450-6029
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070645207RC0000X, 207RI0011X
KY29405207RC0000X, 207RI0011X
IN01041086A207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100344050Medicaid
17146OtherCIGNA
000000042516OtherANTHEM
195834OtherHEALTHLINK
0000047569-01OtherWELBORN HEALTH PLANS
KY64875065Medicaid
839414POtherSIHO
17146OtherCIGNA
KY0255510Medicare PIN
000000042516OtherANTHEM
0000047569-01OtherWELBORN HEALTH PLANS