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General NPI Number Information
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NPI Number | 1841596152
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Entity Type | Individual
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Provider Name | SARATH VASANTH KRISHNAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 10150 NIAGARA LN N STE 210
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7588
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Country | US
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Telephone | 612-871-1145
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14909
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-0909
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Country | US
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Telephone | 612-871-1145
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Fax | 612-870-5491
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD.201923
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 73304
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License Number State | MN
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