Provider Demographics
NPI:1508985201
Name:KRISHNAN, SHANKAR LAKSHMINARAYANAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SHANKAR
Middle Name:LAKSHMINARAYANAN
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:PT, DPT
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Other - First Name:
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Mailing Address - Street 1:2525 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0286
Mailing Address - Country:US
Mailing Address - Phone:248-499-6441
Mailing Address - Fax:248-977-3751
Practice Address - Street 1:2525 S TELEGRAPH RD
Practice Address - Street 2:SUITE 314
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0286
Practice Address - Country:US
Practice Address - Phone:248-499-6441
Practice Address - Fax:248-977-3751
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501009324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6023001Medicare PIN