Provider Demographics
NPI:1134283609
Name:RAMAMURTHY, KANNAN (MD)
Entity Type:Individual
Prefix:MR
First Name:KANNAN
Middle Name:
Last Name:RAMAMURTHY
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 627
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-0627
Mailing Address - Country:US
Mailing Address - Phone:956-631-3982
Mailing Address - Fax:
Practice Address - Street 1:1200 E RIDGE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1527
Practice Address - Country:US
Practice Address - Phone:956-631-3982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD18854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX07960701Medicaid
TXD18854Medicare UPIN
TX85910NMedicare PIN