Provider Demographics
NPI:1467591461
Name:RADHAKRISHNAN, KRISHNAN (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNAN
Middle Name:
Last Name:RADHAKRISHNAN
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 1:111 WASHINGTON AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0003
Mailing Address - Country:US
Mailing Address - Phone:859-218-2100
Mailing Address - Fax:859-257-9862
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506-0001
Practice Address - Country:US
Practice Address - Phone:859-218-2100
Practice Address - Fax:859-257-9862
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR26212083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine