1538168505 NPI number — MADHULIKA KRISH MD

Table of content: MADHULIKA KRISH MD (NPI 1538168505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538168505 NPI number — MADHULIKA KRISH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRISH
Provider First Name:
MADHULIKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538168505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4318 W OKMULGEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKOGEE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74401-4648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-686-0471
Provider Business Mailing Address Fax Number:
918-686-9471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4318 W OKMULGEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKOGEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74401-4648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-686-0471
Provider Business Practice Location Address Fax Number:
918-686-9471
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  30460 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: E3302 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100850740C . This is a "SOONER CARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100850740A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5M288 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 146877001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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