Provider Demographics
NPI:1487636866
Name:MAHALINGAM, KRISHNAMURTHI (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNAMURTHI
Middle Name:
Last Name:MAHALINGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:MAHALINGAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4059 RETREAT DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3099
Mailing Address - Country:US
Mailing Address - Phone:513-325-9025
Mailing Address - Fax:888-972-9271
Practice Address - Street 1:3310 MERCY HEALTH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1121
Practice Address - Country:US
Practice Address - Phone:513-215-5030
Practice Address - Fax:888-972-9271
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037592208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1315389OtherUMWA
OH0052848Medicaid
OH13069OtherNATIONWIDE
OH1138648001OtherCIGNA
OH000000007488OtherANTHEM
OH310837421OtherWAUSAU
OH31083742102OtherEMERALD HEALTH
OH0370058Medicaid
OH0641849OtherAETNA
OH200181050AMedicaid
KY6476721300Medicaid
OH1701223OtherUNITED HEALTHCARE
OH0641849OtherAETNA
OH1315389OtherUMWA
OH1701223OtherUNITED HEALTHCARE
OH020012866Medicare ID - Type UnspecifiedRAILROAD MEDICARE