MEDICARE: KRISHNAKUMAR KUTTAKKATU BALAKRISHNA MENON 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	207R00000X	Internal Medicine Physician	43851	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	110237285	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0403133	OTHER	MN	MEDICA
2	47D66ME	OTHER	MN	BCBS
3	140753	OTHER	MN	UCARE
4	HP33858	OTHER	MN	HEALTH PARTNERS
5	NA2951028011	OTHER	MN	PREFERRED ONE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1542086	OTHER	MN	AMERICAS PPO
8	41084933956001C180	OTHER	MN	CHAMPUS

General Provider Information

NPI Number	:	1740250794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISHNAKUMAR KUTTAKKATU BALAKRISHNA MENON M.D.

Provider Business Mailing Address
First Line	:	800 EAST 28TH STREET
Second Line	:	INTERNAL MAIL ROUTE 11326
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3799
Country	:	US
Telephone Number	:	612-863-1893
Fax Number	:	612-863-3809

Provider Business Practice Location Address
First Line	:	800 EAST 28TH STREET
Second Line	:	INTERNAL MAIL ROUTE 11326
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3799
Country	:	US
Telephone Number	:	612-863-1893
Fax Number	:	612-863-3809

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	03/11/2021

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