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General NPI Number Information
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NPI Number | 1912903782
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Entity Type | Organization
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Legal Business Name | SUNDER KRISHNAN, MD, PLLC
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 S UNIVERSITY AVE STE 519
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5350
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Country | US
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Telephone | 501-975-5005
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Fax | 501-975-5008
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Provider Business Mailing Address
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Address Line | PO BOX 34113
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City | LITTLE ROCK
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State | AR
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Zip | 72203-4113
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Country | US
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Telephone | 501-975-5005
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Fax | 501-975-5008
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARY JOAN AUGHENBAUGH
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Credential |
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Telephone | 501-975-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | E2047
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License Number State | AR
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