MEDICARE: DR. HARI KRISHNA SUSARLA M.D.

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	208000000X	Pediatrics Physician	L7205	TX
2	207R00000X	Internal Medicine Physician	L7205	TX

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	:	1700873262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARI KRISHNA SUSARLA M.D.

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PARKWAY HR/CREDENTIALING SERVICES
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	837 FM 1960 RD W
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77090-3423
Country	:	US
Telephone Number	:	281-586-3888
Fax Number	:	281-440-2020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	06/26/2023

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