Provider Demographics
NPI:1437149630
Name:TALUKDAR, SUBRATA KRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBRATA
Middle Name:KRISHNA
Last Name:TALUKDAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4411 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3824
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-2413
Practice Address - Street 1:12446 WEST AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2530
Practice Address - Country:US
Practice Address - Phone:210-386-5400
Practice Address - Fax:210-525-1669
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL9047207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170128604Medicaid
TX8DB260OtherBCBS OF TX
TXP01076448OtherRAILROAD MEDICARE
TXTXB142173OtherMEDICARE
TX170128604Medicaid
TXTXB142173OtherMEDICARE
TXP01076448OtherRAILROAD MEDICARE
8CN217OtherBCBS TX