Provider Demographics
NPI:1821328089
Name:KRISHAN ARIYARATHNA MD PC
Entity Type:Organization
Organization Name:KRISHAN ARIYARATHNA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIYARATHNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-861-6438
Mailing Address - Street 1:4516 S 179TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3647
Mailing Address - Country:US
Mailing Address - Phone:402-861-6438
Mailing Address - Fax:
Practice Address - Street 1:4516 S 179TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3647
Practice Address - Country:US
Practice Address - Phone:402-861-6438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty