Individual
KRISHNA GANNAMANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1345 UNITY PL STE 110, LAFAYETTE, IN 47905-5768
(765) 807-2787
(765) 807-2789
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01059023A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200486540A
—
IN
Enumeration date
03/10/2006
Last updated
08/06/2021
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