Provider Demographics
NPI:1740787902
Name:PORANDLA, MURALIKRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:MURALIKRISHNA
Middle Name:
Last Name:PORANDLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MERCY ST. VINCENT MEDICAL CENTER
Mailing Address - Street 2:2213 CHERRY STREET
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608
Mailing Address - Country:US
Mailing Address - Phone:419-251-4554
Mailing Address - Fax:419-251-6795
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-441-5005
Practice Address - Fax:479-441-4917
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-14626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program