Basic Information
| Provider Information | |||||||||
| NPI: | 1689883993 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRISHNAN | ||||||||
| FirstName: | PRASHANT | ||||||||
| MiddleName: | VASANTH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2920 N CASCADE AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809076262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196361201 | ||||||||
| FaxNumber: | 7196361326 | ||||||||
| Practice Location | |||||||||
| Address1: | 2920 N CASCADE AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809076262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196361201 | ||||||||
| FaxNumber: | 7196361326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 10/11/2019 | ||||||||
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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 | 207RG0100X | 48094 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 66681235 | 05 | CO | MEDICAID |