Healthcare Provider Details

I. General information

NPI: 1497895361
Provider Name (Legal Business Name): MADHU K. KRIS M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W OLIVE AVE SUITE 107A
MERCED CA
95348-2436
US

IV. Provider business mailing address

750 W OLIVE AVE SUITE 107
MERCED CA
95348-2436
US

V. Phone/Fax

Practice location:
  • Phone: 209-384-3116
  • Fax:
Mailing address:
  • Phone: 209-384-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MADHU K KRIS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 209-384-3116