Individual
KRISHNAVENI GORANTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9130 COLUMBIA AVE, SUITE B, MUNSTER, IN 46321
(219) 836-8803
(219) 836-8820
Mailing address
9130 COLUMBIA AVE, SUITE B, MUNSTER, IN 46321
(219) 836-8803
(219) 836-8820
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01033050A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100169620A
—
IN
Enumeration date
08/31/2006
Last updated
07/08/2007
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