Provider Demographics
NPI:1639112303
Name:MALINENI, KRISHNA C (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:C
Last Name:MALINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8075 N SHADELAND AVE
Practice Address - Street 2:#200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2693
Practice Address - Country:US
Practice Address - Phone:317-621-8500
Practice Address - Fax:317-621-8501
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067505A207RC0000X, 207RC0001X
IL036107040207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616378OtherBCBS
ILP00427560OtherRRMC-LOCALITY 15
INP00798870OtherRR MEDICARE PTAN
INP01214659OtherRR MEDICARE PTAN
1316998578OtherNPI GROUP PRACTICE
ILK40685OtherMEDICARE PIN-LOCALITY 15
ILK40686OtherMEDICARE PIN-LOCALITY 16
ILP00427560OtherRRMC-LOCALITY 15
IN266180150Medicare PIN