MEDICARE: DR. TITTE SESHADRI KRISHNASWAMY M.D.

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	207RC0000X	Cardiovascular Disease Physician	00019181	WA

General Provider Information

NPI Number	:	1376639187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TITTE SESHADRI KRISHNASWAMY M.D.

Provider Business Mailing Address
First Line	:	P.O.BOX 98765
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-0765
Country	:	US
Telephone Number	:	253-589-0175
Fax Number	:	253-589-0175

Provider Business Practice Location Address
First Line	:	253 RIGNEY ROAD
Second Line	:	#D5
City	:	STEILACOOM
State	:	WA
Zip	:	98388
Country	:	US
Telephone Number	:	253-589-0175
Fax Number	:	253-589-0175

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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