Provider Demographics
NPI:1275091217
Name:SUBRAMANIAM KRISHNAMURTHI
Entity Type:Organization
Organization Name:SUBRAMANIAM KRISHNAMURTHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-227-3914
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100248510AMedicaid