Provider Demographics
NPI:1164400321
Name:UNNI, K KRISHNAN (MD)
Entity Type:Individual
Prefix:
First Name:K
Middle Name:KRISHNAN
Last Name:UNNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KOLATHUR
Other - Middle Name:K
Other - Last Name:UNNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:507-284-1599
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:507-284-1599
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20959207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34932400Medicaid
WI34932400Medicaid
WI34932400Medicaid
WI003868230Medicare PIN