Provider Demographics
NPI:1518979012
Name:KRISHNA, MURALI (MD)
Entity type:Individual
Prefix:
First Name:MURALI
Middle Name:
Last Name:KRISHNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MURALI
Other - Middle Name:
Other - Last Name:KRISHNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1009 HARVIN WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3282
Mailing Address - Country:US
Mailing Address - Phone:321-301-4546
Mailing Address - Fax:321-301-4547
Practice Address - Street 1:1009 HARVIN WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3282
Practice Address - Country:US
Practice Address - Phone:321-301-4546
Practice Address - Fax:321-301-4547
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107920207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205345Medicaid
NH30205345Medicaid
NHI41162Medicare UPIN