MEDICARE: SUBRAMANIAM KRISHNAMURTHI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275091217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBRAMANIAM KRISHNAMURTHI

Provider Business Mailing Address
First Line	:	114 S MISSION ST
Second Line	:
City	:	SAPULPA
State	:	OK
Zip	:	74066-4637
Country	:	US
Telephone Number	:	918-227-3914
Fax Number	:	918-227-3922

Provider Business Practice Location Address
First Line	:	114 S MISSION ST
Second Line	:
City	:	SAPULPA
State	:	OK
Zip	:	74066-4637
Country	:	US
Telephone Number	:	918-227-3914
Fax Number	:	918-227-3922

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. DIANNA NENA
Credential	:
Telephone Number	:	918-227-3914

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	03/08/2019

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