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NPI Code Detail

MEDICARE: KRISHNA SANKARAN MD

MEDICARE: KRISHNA SANKARAN 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
1207RN0300XNephrology Physician036079225IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31616108OTHERILBCBS

General Provider Information

NPI Number : 1558353631
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISHNA SANKARAN MD
Provider Business Mailing Address
First Line : 612 ROXBURY RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-5089
Country : US
Telephone Number : 815-227-8300
Fax Number : 815-227-8301
Provider Business Practice Location Address
First Line : 612 ROXBURY RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-5089
Country : US
Telephone Number : 815-227-8300
Fax Number : 815-227-8301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 04/22/2011

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