MEDICARE: KRISHNA RAO SURAPANENI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	E-12069	AR
2	207W00000X	Ophthalmology Physician	S3884	TX

General Provider Information

NPI Number	:	1215321427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISHNA RAO SURAPANENI MD

Provider Business Mailing Address
First Line	:	2601 WESTHEIMER RD STE C200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1662
Country	:	US
Telephone Number	:	713-730-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 WESTHEIMER RD STE C200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1662
Country	:	US
Telephone Number	:	713-730-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	06/11/2024

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