Provider Demographics
NPI:1912903782
Name:SUNDER KRISHNAN, MD, PLLC
Entity type:Organization
Organization Name:SUNDER KRISHNAN, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:AUGHENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-975-5005
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 1:500 S UNIVERSITY AVE
Practice Address - Street 2:STE 519
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5350
Practice Address - Country:US
Practice Address - Phone:501-975-5005
Practice Address - Fax:501-975-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2047208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C9B2Medicare ID - Type Unspecified