Provider Demographics
NPI:1720192255
Name:MURTHY, SHEDTHIKERE KRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEDTHIKERE
Middle Name:KRISHNA
Last Name:MURTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHEDTHIKERE
Other - Middle Name:
Other - Last Name:KRISHNAMURTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8010 STATE LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3711
Mailing Address - Country:US
Mailing Address - Phone:816-830-4285
Mailing Address - Fax:913-400-3631
Practice Address - Street 1:800 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1954
Practice Address - Country:US
Practice Address - Phone:575-894-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2022-03372084N0400X
KS04-444212084N0400X
SC229022084N0400X
GA501962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT71749Medicaid
SCH542067249Medicare ID - Type Unspecified
SCH54206Medicare UPIN