Provider Demographics
NPI:1033116694
Name:SWAMINATHAN, KRISHNASWAMY (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNASWAMY
Middle Name:
Last Name:SWAMINATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:K
Other - Middle Name:
Other - Last Name:SWAMINATHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:150 SE 17TH ST
Mailing Address - Street 2:STE 504
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5176
Mailing Address - Country:US
Mailing Address - Phone:352-629-2250
Mailing Address - Fax:352-629-0056
Practice Address - Street 1:1054 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4221
Practice Address - Country:US
Practice Address - Phone:352-732-3036
Practice Address - Fax:352-368-3940
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2014-07-24
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
FLME78141208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2590042-00Medicaid
FL2590042-00Medicaid
FL47157AMedicare UPIN