Individual
DR. TANGELLA V. KRISHNARAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3981
(217) 337-2310
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 337-2310
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036-108746
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036108746 1
—
IL
01
—
279500
MEDICARE GROUP
—
01
—
P00010307
RAILROAD MEDICARE
—
Enumeration date
08/08/2006
Last updated
01/06/2022
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