Provider Demographics
NPI:1063710366
Name:MYTHILI SRIKRISHNAN MD
Entity type:Organization
Organization Name:MYTHILI SRIKRISHNAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYTHILI
Authorized Official - Middle Name:TAMARAPU
Authorized Official - Last Name:SRIKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-937-3255
Mailing Address - Street 1:12845 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1223
Mailing Address - Country:US
Mailing Address - Phone:716-937-3255
Mailing Address - Fax:716-937-1110
Practice Address - Street 1:12845 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1223
Practice Address - Country:US
Practice Address - Phone:716-937-3255
Practice Address - Fax:716-937-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty