Provider Demographics
NPI:1063537645
Name:KRISHNAN, GANAPATHY S (MD)
Entity type:Individual
Prefix:
First Name:GANAPATHY
Middle Name:S
Last Name:KRISHNAN
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 1:3700 PACIFIC HWY E STE 100
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-1160
Mailing Address - Country:US
Mailing Address - Phone:253-382-6300
Mailing Address - Fax:253-382-6301
Practice Address - Street 1:3700 PACIFIC HWY E STE 100
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1160
Practice Address - Country:US
Practice Address - Phone:253-382-6300
Practice Address - Fax:253-382-6301
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61442553207RH0003X
MI4301064129207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology