Provider Demographics
NPI:1467758532
Name:ANANTH KRISHNAN,P.A.
Entity Type:Organization
Organization Name:ANANTH KRISHNAN,P.A.
Other - Org Name:LAND FAMILY HEALTH CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-736-6066
Mailing Address - Street 1:665 PEACHWOOD DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0903
Mailing Address - Country:US
Mailing Address - Phone:386-736-6066
Mailing Address - Fax:386-738-5890
Practice Address - Street 1:665 PEACHWOOD DR
Practice Address - Street 2:SUITE 2
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0903
Practice Address - Country:US
Practice Address - Phone:386-736-6066
Practice Address - Fax:386-738-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260726300Medicaid
FL2655313Medicare PIN
FLF87943Medicare UPIN