Healthcare Provider Details

I. General information

NPI: 1477629525
Provider Name (Legal Business Name): ANANTHALAKSHMI KRISHNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 CAPE CORAL PKWY E STE 103
CAPE CORAL FL
33904-8522
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9888
  • Fax: 239-468-7937
Mailing address:
  • Phone: 239-343-9888
  • Fax: 239-468-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME57036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: