Healthcare Provider Details

I. General information

NPI: 1982919338
Provider Name (Legal Business Name): KC KRISHNAMURTHI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 BANEY RD S
ASHLAND OH
44805-4502
US

IV. Provider business mailing address

1941 BANEY RD S
ASHLAND OH
44805-4502
US

V. Phone/Fax

Practice location:
  • Phone: 419-289-3355
  • Fax: 419-281-6444
Mailing address:
  • Phone: 419-289-3355
  • Fax: 419-281-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35033441
License Number StateOH

VIII. Authorized Official

Name: KRISHNASWAMY CHENROYAN KRISHNAMURTHI
Title or Position: PRESIDENT
Credential: MD
Phone: 419-289-3355