Provider Demographics
NPI:1851944664
Name:KRISHNAN VENUGOPAL KRISHNARAJ, BALASUNDARI (MD)
Entity Type:Individual
Prefix:
First Name:BALASUNDARI
Middle Name:
Last Name:KRISHNAN VENUGOPAL KRISHNARAJ
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 1:3845 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2919
Mailing Address - Country:US
Mailing Address - Phone:361-854-4626
Mailing Address - Fax:
Practice Address - Street 1:3845 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-2919
Practice Address - Country:US
Practice Address - Phone:361-854-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-20
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT7624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics