Provider Demographics
NPI:1134211865
Name:KRISHNAN, SUJATHA (MD)
Entity type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:
Last Name:KRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:STE 409
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0526
Mailing Address - Country:US
Mailing Address - Phone:214-396-8877
Mailing Address - Fax:214-983-0983
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:STE 409
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0526
Practice Address - Country:US
Practice Address - Phone:214-396-8877
Practice Address - Fax:214-983-0983
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN5166207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283972201Medicaid
TX283972201Medicaid