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General NPI Number Information
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NPI Number | 1629507140
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Entity Type | Individual
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Provider Name | JAY KRISHNAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2061 CORNELL RD FL 4
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City | CLEVELAND
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State | OH
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Zip | 44106-3808
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 259741
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4301112339
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 35.149626
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License Number State | OH
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