Basic Information
| Provider Information | |||||||||
| NPI: | 1376541573 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMBA | ||||||||
| FirstName: | KRISHNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2914 S REPUBLIC BLVD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436151912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195318808 | ||||||||
| FaxNumber: | 4195319342 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 SWEITZER ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375475723 | ||||||||
| FaxNumber: | 9375475784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35083378 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00091244 | 01 | OH | RAILROAD MEDICARE | OTHER | 2500136 | 05 | OH | MEDICAID |