Provider Demographics
NPI:1386641520
Name:KRISHNAN, SUNDER (MD)
Entity type:Individual
Prefix:
First Name:SUNDER
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:PO BOX 34113
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-4113
Mailing Address - Country:US
Mailing Address - Phone:501-975-5005
Mailing Address - Fax:501-975-5008
Practice Address - Street 1:14918 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4248
Practice Address - Country:US
Practice Address - Phone:501-975-5005
Practice Address - Fax:501-975-5008
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2047208VP0014X
TN56788208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136646001Medicaid
AR5C982OtherMCR & BCBS GROUP #
AR5C982OtherMCR & BCBS GROUP #
AR5L163Medicare ID - Type Unspecified