Healthcare Provider Details

I. General information

NPI: 1124339015
Provider Name (Legal Business Name): KRUPA J TRIVEDI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 WILLIAMS TRACE BLVD STE 109
SUGAR LAND TX
77478-4440
US

IV. Provider business mailing address

2225 WILLIAMS TRACE BLVD STE 109
SUGAR LAND TX
77478-4440
US

V. Phone/Fax

Practice location:
  • Phone: 713-614-2857
  • Fax: 713-583-3639
Mailing address:
  • Phone: 713-614-2857
  • Fax: 713-583-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC006234
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO 3596
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006234
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 3596
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2114
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: