Provider Demographics
NPI:1700886900
Name:KRISHNASWAMY, KANNAPPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KANNAPPAN
Middle Name:
Last Name:KRISHNASWAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-3336
Mailing Address - Country:US
Mailing Address - Phone:979-877-0022
Mailing Address - Fax:979-885-3810
Practice Address - Street 1:1036 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3336
Practice Address - Country:US
Practice Address - Phone:979-877-0022
Practice Address - Fax:979-885-3810
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-08-23
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
TXK4113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136449908Medicaid
TX136449909Medicaid
TX8C0851Medicare PIN
TX136449909Medicaid