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General NPI Number Information
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NPI Number | 1881095149
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Entity Type | Individual
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Provider Name | MANJUNATH MASKAL KRISHNAIAH M.D
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Gender | Male
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 1808 7 AVENUE SOUTH 563 BOSHELL BUILDING
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City | BIRMINGHAM
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State | AL
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Zip | 35292
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Country | US
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Telephone | 205-934-9765
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Fax | 205-934-3993
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Provider Business Mailing Address
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Address Line | BDB 563 1720 2ND AVENUE SOUTH
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City | BIRMINGHAM
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State | AL
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Zip | 35294-0012
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Country | US
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Telephone | 205-934-9765
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Fax | 205-934-3993
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | L.4027F
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License Number State | AL
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