Provider Demographics
NPI:1407056906
Name:MUTHU, KRISHNAKUMAR R (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNAKUMAR
Middle Name:R
Last Name:MUTHU
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 1:12221 MERIT DRIVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2202
Mailing Address - Country:US
Mailing Address - Phone:214-217-1911
Mailing Address - Fax:214-217-1912
Practice Address - Street 1:12221 MERIT DRIVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2202
Practice Address - Country:US
Practice Address - Phone:214-217-1911
Practice Address - Fax:214-217-1912
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7091208M00000X
TXN6517208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7091OtherDAKOTACARE
SDP00450058OtherRR MEDICARE
IA140756906Medicaid
SD4992481OtherSD BLUE CROSS
SD6005702Medicaid
SD6005700Medicaid
NE46022474331Medicaid
SD6005700Medicaid
SD4992481OtherSD BLUE CROSS
SD7091OtherDAKOTACARE