Healthcare Provider Details

I. General information

NPI: 1144421777
Provider Name (Legal Business Name): SUDHA RAMAKRISHNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15810 MIDWAY RD
ADDISON TX
75001-4259
US

IV. Provider business mailing address

5080 SPECRUM DR SUITE 1200W
ADDISON TX
75001-4625
US

V. Phone/Fax

Practice location:
  • Phone: 615-778-4066
  • Fax:
Mailing address:
  • Phone: 972-364-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberE7715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: