Provider Demographics
NPI:1518994052
Name:KRISHNARAJAH, AMIRTHANANTHAR (MD)
Entity type:Individual
Prefix:
First Name:AMIRTHANANTHAR
Middle Name:
Last Name:KRISHNARAJAH
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 17366
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78760-7366
Mailing Address - Country:US
Mailing Address - Phone:512-978-9000
Mailing Address - Fax:
Practice Address - Street 1:825 E RUNDBERG LN
Practice Address - Street 2:SUITE F
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4808
Practice Address - Country:US
Practice Address - Phone:512-804-3913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8269207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C8126Medicare PIN
TXG82127Medicare UPIN