Provider Demographics
NPI:1639331887
Name:PALAKODETI, SARATH K (DO)
Entity type:Individual
Prefix:DR
First Name:SARATH
Middle Name:K
Last Name:PALAKODETI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1742
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:
Practice Address - Street 1:484 GOLDEN AUTUMN WAY STE 201
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6914
Practice Address - Country:US
Practice Address - Phone:270-780-0579
Practice Address - Fax:270-936-6029
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP286208600000X
OH34.010446208600000X
GA70564208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0151389Medicaid
OHH269801Medicare PIN