Healthcare Provider Details

I. General information

NPI: 1376129205
Provider Name (Legal Business Name): MR. GANESH SRINIVASAN KRISHNAMURTHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST STE 403
AUSTIN TX
78705-1013
US

IV. Provider business mailing address

1301 W 38TH ST STE 403
AUSTIN TX
78705-1013
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-0301
  • Fax:
Mailing address:
  • Phone: 512-459-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberW6684
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: