Provider Demographics
NPI:1881095149
Name:MASKAL KRISHNAIAH, MANJUNATH (MD)
Entity type:Individual
Prefix:
First Name:MANJUNATH
Middle Name:
Last Name:MASKAL KRISHNAIAH
Suffix:
Gender:M
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:BDB 563
Mailing Address - Street 2:1720 2ND AVENUE SOUTH
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0012
Mailing Address - Country:US
Mailing Address - Phone:205-934-9765
Mailing Address - Fax:205-934-3993
Practice Address - Street 1:1808 7 AVENUE SOUTH
Practice Address - Street 2:563 BOSHELL BUILDING
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35292
Practice Address - Country:US
Practice Address - Phone:205-934-9765
Practice Address - Fax:205-934-3993
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.4027F207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology