Provider Demographics
NPI:1033262712
Name:KRISHNA, SREELATHA KASUGANTI (MD)
Entity Type:Individual
Prefix:DR
First Name:SREELATHA
Middle Name:KASUGANTI
Last Name:KRISHNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9001 S 101ST EAST AVE
Mailing Address - Street 2:STE. 370
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5708
Mailing Address - Country:US
Mailing Address - Phone:918-392-7500
Mailing Address - Fax:918-254-2119
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:STE. 370
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-392-7500
Practice Address - Fax:918-254-2119
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23530207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200119730AMedicaid
OK243727007Medicare PIN