MEDICARE: SUGANTHA 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	208000000X	Pediatrics Physician	36238	AL

General Provider Information

NPI Number	:	1750796967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUGANTHA KRISHNAN MD

Provider Business Mailing Address
First Line	:	1601 4TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-1723
Country	:	US
Telephone Number	:	205-638-9096
Fax Number	:	205-638-2181

Provider Business Practice Location Address
First Line	:	1601 4TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-1723
Country	:	US
Telephone Number	:	205-638-9096
Fax Number	:	205-638-2181

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

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	02/05/2021

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Directions to “ SUGANTHA KRISHNAN MD” Practice Location

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