MEDICARE: MADHAVAN KRISHNAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	A87502	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275515728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHAVAN KRISHNAN MD

Provider Business Mailing Address
First Line	:	27758 SANTA MARGARITA PKWY
Second Line	:	#409
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6709
Country	:	US
Telephone Number	:	949-583-9264
Fax Number	:	949-269-9139

Provider Business Practice Location Address
First Line	:	27725 SANTA MARGARITA PKWY
Second Line	:	STE 101
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6704
Country	:	US
Telephone Number	:	949-462-3999
Fax Number	:	949-462-3777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/12/2011

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Directions to “ MADHAVAN KRISHNAN MD” Practice Location

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