Provider Demographics
NPI:1558593095
Name:MANDA, KRISHNA K R (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA K R
Middle Name:
Last Name:MANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3877
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60434-3877
Mailing Address - Country:US
Mailing Address - Phone:815-741-6830
Mailing Address - Fax:815-741-6832
Practice Address - Street 1:6940 VILLAGREEN VW
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5605
Practice Address - Country:US
Practice Address - Phone:779-774-9272
Practice Address - Fax:779-774-9273
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136899207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology