Organization
LAKE CARDIOVASCULAR INSTITUTE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUTHU S. KRISHNAN MD (MD)
(573) 302-2275
Entity
Organization
Contact information
Practice address
1191 HIGHWAY KK, SUITE 300, OSAGE BEACH, MO 65065-3510
(573) 302-2275
(573) 302-2281
Mailing address
1836 LACKLAND HILL PKWY, ATTNT CREDENTIALING DEPT, SAINT LOUIS, MO 63146-3572
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
R5P38
MO
Other
Enumeration date
07/22/2006
Last updated
08/22/2020
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