Provider Demographics
NPI:1437418746
Name:VIGNESWARAN, KRISHANTHAN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHANTHAN
Middle Name:
Last Name:VIGNESWARAN
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 1:17520 W GRAND PKWY S STE 450
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4983
Mailing Address - Country:US
Mailing Address - Phone:713-486-7800
Mailing Address - Fax:713-486-7830
Practice Address - Street 1:920 FROSTWOOD DR STE 2.300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2314
Practice Address - Country:US
Practice Address - Phone:713-448-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1534207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398138301Medicaid
TX398138302OtherMEDICAID-CSHCN