Provider Demographics
NPI:1467420760
Name:MUTHUSAMY, MURUGAVEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:MURUGAVEL
Middle Name:M
Last Name:MUTHUSAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TECHNOLOGY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-8548
Mailing Address - Country:US
Mailing Address - Phone:812-941-4500
Mailing Address - Fax:
Practice Address - Street 1:11050 PARKVIEW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1739
Practice Address - Country:US
Practice Address - Phone:833-724-8326
Practice Address - Fax:260-425-6845
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23416-875207RH0003X
IL36148444207RH0003X
IN01040972A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5171410005OtherDMERC
5171410004OtherDMERC
WI100219024Medicaid
IN100361800Medicaid
5171410003OtherDMERC