Basic Information
| Provider Information | |||||||||
| NPI: | 1760598668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRISHNAN | ||||||||
| FirstName: | SURESH | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 BUSINESS PARK DR | ||||||||
| Address2: | STE A | ||||||||
| City: | TROY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633792827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6367289460 | ||||||||
| FaxNumber: | 6367751544 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 BUSINESS PARK DR | ||||||||
| Address2: | STE A | ||||||||
| City: | TROY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3663339723 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 11/05/2018 | ||||||||
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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 | 2004011002 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 2004011002 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.