Provider Demographics
NPI:1124339015
Name:TRIVEDI, KRUPA J (DPM)
Entity type:Individual
Prefix:
First Name:KRUPA
Middle Name:J
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 WILLIAMS TRACE BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4440
Mailing Address - Country:US
Mailing Address - Phone:713-614-2857
Mailing Address - Fax:713-583-3639
Practice Address - Street 1:2225 WILLIAMS TRACE BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4440
Practice Address - Country:US
Practice Address - Phone:713-614-2857
Practice Address - Fax:713-583-3639
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006234213EP1101X, 213ES0103X
FLPO 3596213EP1101X, 213ES0103X
TX2114213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1204790001Medicare NSC
TXHG370ZMedicare PIN
FLHG370ZMedicare PIN