Provider Demographics
NPI:1164493870
Name:SUBRAMANYAM, KALYANAM VI (MD)
Entity Type:Individual
Prefix:DR
First Name:KALYANAM
Middle Name:
Last Name:SUBRAMANYAM
Suffix:VI
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 1:1015 MED CENTER BLVD # 1300
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4055
Mailing Address - Country:US
Mailing Address - Phone:281-557-2527
Mailing Address - Fax:281-557-7203
Practice Address - Street 1:1015 MED CENTER BLVD # 1300
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4055
Practice Address - Country:US
Practice Address - Phone:281-557-2527
Practice Address - Fax:281-557-7203
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9035207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4105Medicare PIN
TXB26780Medicare UPIN
TX00FV06Medicare ID - Type UnspecifiedMEDICARE