MEDICARE: DR. AJAY KRISHEN 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	207RC0001X	Clinical Cardiac Electrophysiology Physician	4301079791	MI

General Provider Information

NPI Number	:	1285695452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AJAY KRISHEN MD

Provider Business Mailing Address
First Line	:	1222 10TH AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3406
Country	:	US
Telephone Number	:	810-985-9681
Fax Number	:	810-985-3590

Provider Business Practice Location Address
First Line	:	1222 10TH AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3406
Country	:	US
Telephone Number	:	810-985-9681
Fax Number	:	810-985-3590

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	01/30/2008

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