Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | PO 3596 | FL |
N | 213EP1101X | Primary Podiatric Medicine | SC006234 | PA |
Y | 213ES0103X | Foot & Ankle Surgery | 2114 | TX |
N | 213ES0103X | Foot & Ankle Surgery | PO 3596 | FL |
N | 213ES0103X | Foot & Ankle Surgery | SC006234 | PA |
NPI | 1124339015 |
---|---|
Provider Name | Krupa J Trivedi |
First Address | Sugar Land, TX 77478-4440 |
Second Address | Sugar Land, TX 77478-4440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 15/04/2019 |