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General NPI Number Information
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NPI Number | 1760598668
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Entity Type | Individual
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Provider Name | SURESH K KRISHNAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 60 BUSINESS PARK DR STE A
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City | TROY
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State | MO
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Zip | 63379
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Country | US
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Telephone | 366-333-9723
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Fax |
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Provider Business Mailing Address
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Address Line | 60 BUSINESS PARK DR STE A
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City | TROY
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State | MO
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Zip | 63379-2827
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Country | US
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Telephone | 636-728-9460
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Fax | 636-775-1544
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2004011002
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 2004011002
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License Number State | MO
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