Provider Demographics
NPI:1093824013
Name:VALJEE, KRISHNA D (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:D
Last Name:VALJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 610669
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48061-0669
Mailing Address - Country:US
Mailing Address - Phone:810-216-1884
Mailing Address - Fax:810-216-3025
Practice Address - Street 1:2609 ELECTRIC AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6589
Practice Address - Country:US
Practice Address - Phone:810-216-1148
Practice Address - Fax:810-216-1149
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039219208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3087777Medicaid
D54495Medicare UPIN
M72340006Medicare ID - Type Unspecified