Individual
DR. KUMAR KRISHNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST # STREET4, BOSTON, MA 02114-2621
(617) 724-0578
(617) 724-5997
Mailing address
55 FRUIT ST # STREET4, BOSTON, MA 02114-2621
(617) 724-0578
(617) 724-5997
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036121716
IL
207RG0100X
Gastroenterology Physician
036121716
IL
207RG0100X
Gastroenterology Physician
Primary
272242
MA
207RG0100X
Gastroenterology Physician
Q0093
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340122601
—
TX
05
—
340122602
—
TX
01
—
8EQ228
BLUE CROSS BLUE SHIELD
TX
01
—
8FX432
BLUE CROSS BLUE SHIELD
TX
01
—
BP1-0026146
INSTITUTIONAL PERMIT
—
Enumeration date
05/21/2007
Last updated
10/04/2017
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