Provider Demographics
NPI:1093924037
Name:MURUGAPPAN, MEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MEENA
Middle Name:
Last Name:MURUGAPPAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S 3RD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1952
Mailing Address - Country:US
Mailing Address - Phone:618-624-5800
Mailing Address - Fax:618-624-5825
Practice Address - Street 1:222 S WOODS MILL RD STE 310N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3627
Practice Address - Country:US
Practice Address - Phone:314-682-3630
Practice Address - Fax:314-682-3647
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005015799207R00000X
IL036127822207RP1001X
MO2010003414207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00961367Medicare PIN
IL209308019Medicare PIN
IL217147009Medicare PIN
IL745440012Medicare PIN