Provider Demographics
NPI:1164421343
Name:KRISHNAMURTHI, SUBRAMANIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBRAMANIAM
Middle Name:
Last Name:KRISHNAMURTHI
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 1:114 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4637
Mailing Address - Country:US
Mailing Address - Phone:918-227-3914
Mailing Address - Fax:918-227-3922
Practice Address - Street 1:114 S MISSION ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4637
Practice Address - Country:US
Practice Address - Phone:918-227-3914
Practice Address - Fax:918-227-3922
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100248510AMedicaid
OKE10820Medicare UPIN
OK100248510AMedicaid