MEDICARE: SHRI KRISHAN PC

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	261QP2300X	Primary Care Clinic/Center	21023	AL
2	207R00000X	Internal Medicine Physician	21023	AL

Other Identifiers

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

General Provider Information

NPI Number	:	1821303751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHRI KRISHAN PC

Provider Business Mailing Address
First Line	:	5107 MOORES MILL RD
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-1007
Country	:	US
Telephone Number	:	256-851-7190
Fax Number	:	256-851-7189

Provider Business Practice Location Address
First Line	:	5107 MOORES MILL RD
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-1007
Country	:	US
Telephone Number	:	256-851-7190
Fax Number	:	256-851-7189

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARCHANA RASTOGI
Credential	:	MD
Telephone Number	:	256-426-8393

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	02/03/2011

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Directions to “SHRI KRISHAN PC ” Practice Location

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