Provider Demographics
NPI:1649305913
Name:KRISHNAN, SARITHA TTHITTAPPILLIL (MD)
Entity type:Individual
Prefix:DR
First Name:SARITHA
Middle Name:TTHITTAPPILLIL
Last Name:KRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2873 S INGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-8480
Mailing Address - Country:US
Mailing Address - Phone:913-244-2323
Mailing Address - Fax:
Practice Address - Street 1:2873 S INGRAM AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-8480
Practice Address - Country:US
Practice Address - Phone:913-244-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007031715208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics