Provider Demographics
NPI:1306846969
Name:KANNAN, SUBHASRI (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASRI
Middle Name:
Last Name:KANNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 WADE BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2174
Mailing Address - Country:US
Mailing Address - Phone:972-731-7717
Mailing Address - Fax:972-731-7733
Practice Address - Street 1:9300 WADE BLVD
Practice Address - Street 2:STE 220
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-2174
Practice Address - Country:US
Practice Address - Phone:972-731-7717
Practice Address - Fax:972-731-7733
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1635690Medicaid
TX1635690Medicaid
TX844792Medicare ID - Type Unspecified