Provider Demographics
NPI:1033375092
Name:KRISHNAN, BALA ARUL VINAYAK (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:BALA ARUL
Middle Name:VINAYAK
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:DR
Other - First Name:ARUL
Other - Middle Name:
Other - Last Name:KRISHNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MS
Mailing Address - Street 1:PO BOX 2040
Mailing Address - Street 2:CAMPUS BOX 356540
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2040
Mailing Address - Country:US
Mailing Address - Phone:503-299-9906
Mailing Address - Fax:503-225-9002
Practice Address - Street 1:707 SW WASHINGTON ST
Practice Address - Street 2:SUITE 700
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3536
Practice Address - Country:US
Practice Address - Phone:503-299-9906
Practice Address - Fax:503-225-9002
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD159815207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500649107Medicaid
ORR167913Medicare PIN
ORR167915Medicare PIN
OR500649107Medicaid