Provider Demographics
NPI:1245231604
Name:KRISHNAMURTHY, SATISH (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:
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 1:725 IRVING AVE
Mailing Address - Street 2:STE. 503
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1603
Mailing Address - Country:US
Mailing Address - Phone:315-464-4470
Mailing Address - Fax:315-464-5520
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:STE. 503
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-464-4470
Practice Address - Fax:315-464-5520
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087790207T00000X
NY218149207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SK087790OtherCHAMPUS-CHAMPUS
NY02089449Medicaid
700H262230OtherBLUE CROSS-BLUE CROSS
SK087790OtherCOMMERCIAL-COMMERCIAL NUMBER
MI489591910Medicaid
SK087790OtherCHAMPUS-CHAMPUS
NYCC9332Medicare PIN
700H262230OtherBLUE CROSS-BLUE CROSS