Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 036-107187 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 036.107187 | IL |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 036-107187 | IL |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 036.107187 | IL |
NPI | 1225054505 |
---|---|
Provider Name | Kousik Krishnan |
First Address | Naperville, IL 60540-7430 |
Second Address | Naperville, IL 60540-7430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H68949 | (02) | IL |