Individual
MUTHU S. KRISHNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1191 HIGHWAY KK, SUITE 300, OSAGE BEACH, MO 65065-3510
(573) 302-4960
(573) 302-4965
Mailing address
PO BOX 1500, OSAGE BEACH, MO 65065-1500
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
R5P38
MO
207RI0011X
Interventional Cardiology Physician
Primary
R5P38
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528089539
—
MO
05
—
507408201
—
MO
01
—
P00853879
RAILROAD MEDICARE
MO
Enumeration date
07/22/2006
Last updated
02/18/2011
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