Provider Demographics
NPI:1811939382
Name:KRISHNA, SISTLA B (MD)
Entity type:Individual
Prefix:
First Name:SISTLA
Middle Name:B
Last Name:KRISHNA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7737 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 805
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1806
Mailing Address - Country:US
Mailing Address - Phone:713-988-6774
Mailing Address - Fax:713-771-6074
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:SUITE 805
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-988-6774
Practice Address - Fax:713-771-6074
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF8542207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1375115Medicaid
TX00R93UMedicare ID - Type Unspecified
TX1375115Medicaid