Basic Information
| Provider Information | |||||||||
| NPI: | 1942319934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAMBURI | ||||||||
| FirstName: | KRISHNA | ||||||||
| MiddleName: | MOHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478074214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423175 | ||||||||
| FaxNumber: | 8122423543 | ||||||||
| Practice Location | |||||||||
| Address1: | 1429 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423175 | ||||||||
| FaxNumber: | 8122423543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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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 | 207RC0000X | 01038133A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 36077615 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 100376520Z | 05 | IN | MEDICAID | P00398470 | 01 | RAILROAD MEDICARE | OTHER | P00844276 | 01 | IN | RAILROAD MEDICARE | OTHER | 100376520G | 01 | IN | MOLINA HEALTHCARE MCAID | OTHER | 100376520 | 05 | IN | MEDICAID | 351904269237 | 01 | CARESOURCE MEDICAID | OTHER | 060023841 | 01 | RAILROAD MCARE PALAMETTO | OTHER | 100376520Y | 05 | IN | MEDICAID | 000000089624 | 01 | ANTHEM | OTHER | 060068542 | 01 | IN | RAILROAD MEDICARE | OTHER | 100376520A | 01 | IN | MOLINA HEALTHCARE MCAID | OTHER | 351904269124 | 01 | CARESOURCE MEDICAID | OTHER | 4589941 | 01 | AETNA | OTHER | P01056435 | 01 | IL | RAILROAD MEDICARE | OTHER |