Provider Demographics
NPI:1336300631
Name:TATINENI, KRISHNA CHAITHANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:CHAITHANYA
Last Name:TATINENI
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 1:14660 STATE HIGHWAY 121 STE 200
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-4634
Mailing Address - Country:US
Mailing Address - Phone:469-269-0272
Mailing Address - Fax:469-854-2143
Practice Address - Street 1:14660 STATE HIGHWAY 121 STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4634
Practice Address - Country:US
Practice Address - Phone:469-269-0272
Practice Address - Fax:469-854-2143
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0505261QU0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344362YKY6Medicare PIN