Provider Demographics
NPI:1114152212
Name:S.G.KRISHNAN,M.D. & ASSOCIATES
Entity Type:Organization
Organization Name:S.G.KRISHNAN,M.D. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBRAM
Authorized Official - Middle Name:GOPAL
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-968-9502
Mailing Address - Street 1:1331 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6601
Mailing Address - Country:US
Mailing Address - Phone:956-968-9502
Mailing Address - Fax:956-968-7269
Practice Address - Street 1:1331 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6601
Practice Address - Country:US
Practice Address - Phone:956-968-9502
Practice Address - Fax:956-968-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1357207V00000X
TXE0520207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099673801Medicaid
TX110089302Medicaid
TX00N849Medicare UPIN
TX00P422Medicare UPIN