Provider Demographics
NPI:1063404028
Name:KRISHNARAJ, PANDURANGAN NMI (MD)
Entity type:Individual
Prefix:DR
First Name:PANDURANGAN
Middle Name:NMI
Last Name:KRISHNARAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37840 MEDICAL ARTS CT
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4325
Mailing Address - Country:US
Mailing Address - Phone:813-788-5569
Mailing Address - Fax:813-782-8628
Practice Address - Street 1:37840 MEDICAL ARTS CT
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4325
Practice Address - Country:US
Practice Address - Phone:813-788-5569
Practice Address - Fax:813-782-8628
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52220208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020018582OtherMEDICARE RAILROAD
FL203005OtherAMERIGROUP
FL07560OtherBLUE CROSS BLUE SHIELD FL
FL0624006OtherAETNA HEALTHCARE
0055965OtherGHI
FL049160800Medicaid
FL1705024OtherUNITED HEALTHCARE
FL203772OtherAVMED
FL00641OtherWELLCARE
FL049160800Medicaid
FL203005OtherAMERIGROUP