Provider Demographics
NPI:1871526848
Name:KRISHNAMOORTHY, C V (MD)
Entity type:Individual
Prefix:DR
First Name:C
Middle Name:V
Last Name:KRISHNAMOORTHY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3019 COIT NE
Mailing Address - Street 2:VA OUTPATIENT CLINIC
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505
Mailing Address - Country:US
Mailing Address - Phone:616-365-9575
Mailing Address - Fax:616-365-9480
Practice Address - Street 1:3019 COIT AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3376
Practice Address - Country:US
Practice Address - Phone:616-365-9575
Practice Address - Fax:616-365-9480
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010490862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry