Provider Demographics
NPI:1518286558
Name:SHANMUGAM, KRISHNA PRAHALAD (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:PRAHALAD
Last Name:SHANMUGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:223 INDIANA AVE
Mailing Address - Street 2:APT 2314
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-3370
Mailing Address - Country:US
Mailing Address - Phone:979-255-3738
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:MS 6211
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-6211
Practice Address - Country:US
Practice Address - Phone:806-743-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP30040315207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology