Provider Demographics
NPI:1205832102
Name:KRISHNA, SANGEETA (MD)
Entity Type:Individual
Prefix:
First Name:SANGEETA
Middle Name:
Last Name:KRISHNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE STE S1-20
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-1033
Mailing Address - Country:US
Mailing Address - Phone:216-444-4998
Mailing Address - Fax:216-636-3363
Practice Address - Street 1:9500 EUCLID AVE STE S1-20
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1033
Practice Address - Country:US
Practice Address - Phone:216-444-4998
Practice Address - Fax:216-636-3363
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35897208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000208466OtherANTHEM
KY64038201Medicaid
KY0538732Medicare ID - Type UnspecifiedPX
KY0637708Medicare ID - Type UnspecifiedPO
KY64038201Medicaid
KY0538531Medicare ID - Type UnspecifiedFD
KY0538632Medicare ID - Type UnspecifiedIQ
KYH42744Medicare UPIN