Provider Demographics
NPI:1952373805
Name:KRISHNA, SHIVA S (MD)
Entity Type:Individual
Prefix:
First Name:SHIVA
Middle Name:S
Last Name:KRISHNA
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 1:101 WESTOVER CIR STE C
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-4910
Mailing Address - Country:US
Mailing Address - Phone:256-890-0331
Mailing Address - Fax:256-325-1189
Practice Address - Street 1:1201 8TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3356
Practice Address - Country:US
Practice Address - Phone:256-560-0646
Practice Address - Fax:256-560-0649
Is Sole Proprietor?:No
Enumeration Date:2006-02-05
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25205207K00000X
AL00025205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00025205OtherAL. STATE LICENSE #
AL221879Medicaid
AL182367Medicaid