Healthcare Provider Details

I. General information

NPI: 1912903782
Provider Name (Legal Business Name): SUNDER KRISHNAN, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE STE 519
LITTLE ROCK AR
72205-5350
US

IV. Provider business mailing address

PO BOX 34113
LITTLE ROCK AR
72203-4113
US

V. Phone/Fax

Practice location:
  • Phone: 501-975-5005
  • Fax: 501-975-5008
Mailing address:
  • Phone: 501-975-5005
  • Fax: 501-975-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberE2047
License Number StateAR

VIII. Authorized Official

Name: MS. MARY JOAN AUGHENBAUGH
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-975-5005