Provider Demographics
NPI:1982699682
Name:SHIVSHANKER, KRISHNAMURTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNAMURTHY
Middle Name:
Last Name:SHIVSHANKER
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 1:7737 SOUTHWEST FWY
Mailing Address - Street 2:SUITE #840
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1807
Mailing Address - Country:US
Mailing Address - Phone:713-777-2555
Mailing Address - Fax:713-777-1562
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:SUITE #840
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-777-2555
Practice Address - Fax:713-777-1562
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132409702Medicaid
TXC21769Medicare UPIN
TX88G776Medicare ID - Type Unspecified