Healthcare Provider Details

I. General information

NPI: 1235197807
Provider Name (Legal Business Name): RAJAN KRISHNAMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 E GALBRAITH RD STE 200
CINCINNATI OH
45236-6704
US

IV. Provider business mailing address

4760 E GALBRAITH RD STE 200
CINCINNATI OH
45236-6704
US

V. Phone/Fax

Practice location:
  • Phone: 513-735-1529
  • Fax: 513-686-5620
Mailing address:
  • Phone: 513-735-1529
  • Fax: 513-686-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number227409
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.094213
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: