Provider Demographics
NPI:1770726291
Name:KRISHNAMURTHY, KARTHIK (DO)
Entity type:Individual
Prefix:DR
First Name:KARTHIK
Middle Name:
Last Name:KRISHNAMURTHY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 OLD KINGS RD N
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8227
Mailing Address - Country:US
Mailing Address - Phone:386-677-9044
Mailing Address - Fax:386-677-3083
Practice Address - Street 1:37 OLD KINGS RD N
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8227
Practice Address - Country:US
Practice Address - Phone:904-541-0315
Practice Address - Fax:904-541-0316
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12510207N00000X
NY241077207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14Y1XOtherBCBS
FLHZ573ZMedicare PIN