Provider Demographics
NPI:1861611675
Name:KRISHNAN, PREETHI SIVARAMA (MD)
Entity type:Individual
Prefix:
First Name:PREETHI
Middle Name:SIVARAMA
Last Name:KRISHNAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-713-7422
Mailing Address - Fax:405-713-7436
Practice Address - Street 1:3330 NW 56TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4479
Practice Address - Country:US
Practice Address - Phone:405-713-7422
Practice Address - Fax:405-713-7436
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2017-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK26009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine