Healthcare Provider Details

I. General information

NPI: 1891930863
Provider Name (Legal Business Name): VAMSI KRISHNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SETON PKWY SUITE 450
KYLE TX
78640-6178
US

IV. Provider business mailing address

1400 N IH 35 SUITE 300
AUSTIN TX
78701-1926
US

V. Phone/Fax

Practice location:
  • Phone: 512-504-0860
  • Fax: 512-504-0861
Mailing address:
  • Phone: 512-324-8300
  • Fax: 512-324-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberQ1437
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: