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General NPI Number Information
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NPI Number | 1619437290
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Entity Type | Individual
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Provider Name | CHENTHAN KRISHNAKUMAR MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 740 S LIMESTONE STE K201
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City | LEXINGTON
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State | KY
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Zip | 40536-4637
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Country | US
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Telephone | 859-323-6211
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Fax | 859-257-0491
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Provider Business Mailing Address
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Address Line | 625 NW 182ND ST
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City | EDMOND
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State | OK
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Zip | 73012-4582
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Country | US
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Telephone | 224-302-2740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 39679
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | TP458
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License Number State | KY
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