Provider Demographics
NPI:1316046261
Name:KRISHNAN, SUNIL (MD)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST STE 2070
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1541
Mailing Address - Country:US
Mailing Address - Phone:713-486-7747
Mailing Address - Fax:
Practice Address - Street 1:6400 FANNIN ST STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1553
Practice Address - Country:US
Practice Address - Phone:713-704-2650
Practice Address - Fax:713-704-5710
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142499207RH0003X
TXL92952085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00618593OtherRR MEDICARE
TX166006001Medicaid
TX8K3838OtherBCBS
TX166006001Medicaid
TXP00618593OtherRR MEDICARE