Provider Demographics
NPI:1982919338
Name:KC KRISHNAMURTHI MD INC
Entity type:Organization
Organization Name:KC KRISHNAMURTHI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNASWAMY
Authorized Official - Middle Name:CHENROYAN
Authorized Official - Last Name:KRISHNAMURTHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-289-3355
Mailing Address - Street 1:1941 BANEY RD S
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4502
Mailing Address - Country:US
Mailing Address - Phone:419-289-3355
Mailing Address - Fax:419-281-6444
Practice Address - Street 1:1941 BANEY RD S
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4502
Practice Address - Country:US
Practice Address - Phone:419-289-3355
Practice Address - Fax:419-281-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0169071Medicaid
OH0169071Medicaid