Provider Demographics
NPI:1619437290
Name:KRISHNAKUMAR, CHENTHAN (MD)
Entity type:Individual
Prefix:
First Name:CHENTHAN
Middle Name:
Last Name:KRISHNAKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 NW 182ND ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4582
Mailing Address - Country:US
Mailing Address - Phone:224-302-2740
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE K201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-4637
Practice Address - Country:US
Practice Address - Phone:859-323-6211
Practice Address - Fax:859-257-0491
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK396792080P0206X
KYTP4582080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6700889Medicaid