Provider Demographics
NPI:1083623565
Name:KRISHNAMURTHY, ASHOK S (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:S
Last Name:KRISHNAMURTHY
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:PO BOX 850001 DEPT #217
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0001
Mailing Address - Country:US
Mailing Address - Phone:941-345-1950
Mailing Address - Fax:941-345-1951
Practice Address - Street 1:4351 CORTEZ RD W STE 200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3217
Practice Address - Country:US
Practice Address - Phone:941-345-1950
Practice Address - Fax:941-345-1951
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107232207RC0000X, 207UN0901X, 207RC0000X, 207RI0011X, 207UN0901X
CT042057207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149WKOtherBCBS
FL003520800Medicaid
CT001420570Medicaid
FLI26250Medicare UPIN
FL003520800Medicaid
FLDY722YMedicare PIN
CT001420570Medicaid