Healthcare Provider Details

I. General information

NPI: 1225054505
Provider Name (Legal Business Name): KOUSIK KRISHNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MARTIN AVE STE 200
NAPERVILLE IL
60540-6535
US

IV. Provider business mailing address

10 MARTIN AVE STE 200
NAPERVILLE IL
60540-6535
US

V. Phone/Fax

Practice location:
  • Phone: 630-600-0700
  • Fax: 630-600-0701
Mailing address:
  • Phone: 630-600-0700
  • Fax: 630-600-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036-107187
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.107187
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036-107187
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036.107187
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: