Provider Demographics
NPI:1174595243
Name:RAJANNA, KRISHNA R (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:R
Last Name:RAJANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6420 PROSPECT AVE
Mailing Address - Street 2:T-207
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4147
Mailing Address - Country:US
Mailing Address - Phone:816-276-9100
Mailing Address - Fax:816-276-9101
Practice Address - Street 1:6420 PROSPECT AVE
Practice Address - Street 2:T-207
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4147
Practice Address - Country:US
Practice Address - Phone:816-276-9100
Practice Address - Fax:816-276-9101
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007006305208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200589130AMedicaid
MOPIN 1174595243Medicaid
MOP00396076OtherRAILROAD MEDICARE
KSP00679195OtherRAILROAD MEDICARE
MO205467806Medicaid
KSP00679195OtherRAILROAD MEDICARE
MO965283557Medicare PIN
MO205467806Medicaid