Provider Demographics
NPI:1205240983
Name:RAMIAH KRISHNAN
Entity type:Organization
Organization Name:RAMIAH KRISHNAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-772-8900
Mailing Address - Street 1:126 DEL PRADO BLVD N
Mailing Address - Street 2:SUIT 102
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2713
Mailing Address - Country:US
Mailing Address - Phone:239-772-8900
Mailing Address - Fax:239-772-4219
Practice Address - Street 1:126 DEL PRADO BLVD N
Practice Address - Street 2:SUIT 102
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2713
Practice Address - Country:US
Practice Address - Phone:239-772-8900
Practice Address - Fax:239-772-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053442102Medicaid
FL10436BMedicare PIN