Provider Demographics
NPI:1104920776
Name:KRISHNAN, MEERA (MD)
Entity type:Individual
Prefix:
First Name:MEERA
Middle Name:
Last Name:KRISHNAN
Suffix:
Gender:
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:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5770
Practice Address - Fax:573-331-3974
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082563207R00000X, 208M00000X
MO2011037090208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00285269OtherRAILROAD MEDICARE
IL01621926OtherBLUE CROSS BLUE SHIELD
IL01621926OtherBLUE CROSS BLUE SHIELD
ILK21472Medicare ID - Type UnspecifiedMEDICARE
ILF09472Medicare UPIN