Basic Information
| Provider Information | |||||||||
| NPI: | 1477629525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRISHNAN | ||||||||
| FirstName: | ANANTHALAKSHMI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10091 MAGNOLIA POINTE | ||||||||
| Address2: | |||||||||
| City: | FT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397723295 | ||||||||
| FaxNumber: | 2397724219 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 DEL PRADO BLVD N | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CAPE CORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339092702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397723295 | ||||||||
| FaxNumber: | 2397724219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 03/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME57036 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 053542700 | 05 | FL | MEDICAID | BLUE CROSS BLUE SHEI | 01 | FL | BCBS OF FLORIDA | OTHER |