Individual
DR. KANAKAPURA VENKATAKRISHNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11104 PARKVIEW CIRCLE DR, ENTRANCE 11, SUITE 330, FORT WAYNE, IN 46845-1730
(260) 494-3484
(260) 969-0188
Mailing address
120 W 22ND ST STE 200, OAK BROOK, IL 60523-1563
(630) 573-5000
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01045053A
IN
207RN0300X
Nephrology Physician
35.067919
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095598
BCBS
IN
05
—
0310587
—
OH
05
—
100082060
—
IN
05
—
200093260
—
IN
Enumeration date
08/10/2005
Last updated
11/18/2022
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