Provider Demographics
NPI:1962854737
Name:UMAPATHI, KRISHNA KISHORE (MBBS, MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA KISHORE
Middle Name:
Last Name:UMAPATHI
Suffix:
Gender:M
Credentials:MBBS, MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 DES PLAINES AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1846
Mailing Address - Country:US
Mailing Address - Phone:216-309-5642
Mailing Address - Fax:
Practice Address - Street 1:800 PENNSYLVANIA AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3351
Practice Address - Country:US
Practice Address - Phone:216-309-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361498602080P0202X
OH57.028502390200000X
WV312012080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program