Provider Demographics
NPI:1003047564
Name:MURUKESAN, VIDHYA (MB,BS)
Entity Type:Individual
Prefix:DR
First Name:VIDHYA
Middle Name:
Last Name:MURUKESAN
Suffix:
Gender:F
Credentials:MB,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 30TH ST
Mailing Address - Street 2:CREIGHTON UNIVERSITY - GME
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2137
Mailing Address - Country:US
Mailing Address - Phone:402-280-5250
Mailing Address - Fax:
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:CREIGHTON UNIVERSITY - GME
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-280-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5995 TEP207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine