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General NPI Number Information
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NPI Number | 1154787307
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Entity Type | Individual
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Provider Name | KRANTHI NANDAN SEELABOYINA M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 316 SECOR ST
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City | MIDLAND
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State | TX
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Zip | 79701-6343
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Country | US
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Telephone | 432-620-1111
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Fax | 432-620-1112
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Provider Business Mailing Address
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Address Line | 701 W 5TH ST STE 3142
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City | ODESSA
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State | TX
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Zip | 79763-4206
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Country | US
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Telephone | 432-703-5310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD2022-0323
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 300619
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | S9407
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License Number State | TX
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