Provider Demographics
NPI:1740250794
Name:BALAKRISHNA MENON, KRISHNAKUMAR KUTTAKKATU (MD)
Entity type:Individual
Prefix:
First Name:KRISHNAKUMAR
Middle Name:KUTTAKKATU
Last Name:BALAKRISHNA MENON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KRISHNA
Other - Middle Name:K
Other - Last Name:MENON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 EAST 28TH STREET
Mailing Address - Street 2:INTERNAL MAIL ROUTE 11326
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3799
Mailing Address - Country:US
Mailing Address - Phone:612-863-1893
Mailing Address - Fax:612-863-3809
Practice Address - Street 1:800 EAST 28TH STREET
Practice Address - Street 2:INTERNAL MAIL ROUTE 11326
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3799
Practice Address - Country:US
Practice Address - Phone:612-863-1893
Practice Address - Fax:612-863-3809
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0403133OtherMEDICA
MN47D66MEOtherBCBS
MN140753OtherUCARE
MNHP33858OtherHEALTH PARTNERS
MNNA2951028011OtherPREFERRED ONE
MN110114500Medicaid
MN1542086OtherAMERICAS PPO
MN41084933956001C180OtherCHAMPUS
110237285OtherRR MEDICARE
MN110114500Medicaid
MN1542086OtherAMERICAS PPO
H01035Medicare UPIN