Provider Demographics
NPI:1265480685
Name:KRISHNAN, RUTH NISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:NISHA
Last Name:KRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:NISHA
Other - Last Name:SUNDARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4001 WORTH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1608
Mailing Address - Country:US
Mailing Address - Phone:214-828-1745
Mailing Address - Fax:214-828-1734
Practice Address - Street 1:4001 WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1608
Practice Address - Country:US
Practice Address - Phone:214-828-1745
Practice Address - Fax:214-828-1734
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000039396207R00000X
TXN6438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216944301Medicaid
TX8CL572OtherBCBSTX
TXTXB111754Medicare PIN
TNI354370Medicare UPIN
TN3331268Medicare ID - Type Unspecified