Provider Demographics
NPI:1275760464
Name:KANNAN, MURALIDHAR (MD)
Entity Type:Individual
Prefix:
First Name:MURALIDHAR
Middle Name:
Last Name:KANNAN
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 1:1345 RIVER BEND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-6945
Mailing Address - Country:US
Mailing Address - Phone:214-743-1200
Mailing Address - Fax:
Practice Address - Street 1:3330 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4531
Practice Address - Country:US
Practice Address - Phone:214-371-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4351872084P0800X
TXQ54482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA163341OtherMEDICARE
PA1023388480001Medicaid