Healthcare Provider Details

I. General information

NPI: 1760598668
Provider Name (Legal Business Name): SURESH K KRISHNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BUSINESS PARK DR STE A
TROY MO
63379
US

IV. Provider business mailing address

60 BUSINESS PARK DR STE A
TROY MO
63379-2827
US

V. Phone/Fax

Practice location:
  • Phone: 366-333-9723
  • Fax:
Mailing address:
  • Phone: 636-728-9460
  • Fax: 636-775-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2004011002
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2004011002
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: