Provider Demographics
NPI:1760598668
Name:KRISHNAN, SURESH K (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:K
Last Name:KRISHNAN
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 1:60 BUSINESS PARK DR
Mailing Address - Street 2:STE A
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-2827
Mailing Address - Country:US
Mailing Address - Phone:636-728-9460
Mailing Address - Fax:636-775-1544
Practice Address - Street 1:60 BUSINESS PARK DR
Practice Address - Street 2:STE A
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379
Practice Address - Country:US
Practice Address - Phone:366-333-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004011002207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA5641001Medicare PIN
MOMA1934001Medicare PIN