Provider Demographics
NPI:1497703367
Name:MURPHY, PATRICK B (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:B
Last Name:MURPHY
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 1:1770 E LAKE SHORE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3800
Mailing Address - Country:US
Mailing Address - Phone:217-422-6100
Mailing Address - Fax:833-784-5326
Practice Address - Street 1:1770 E LAKE SHORE DR STE 105
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3800
Practice Address - Country:US
Practice Address - Phone:217-422-6100
Practice Address - Fax:833-784-5326
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076395207RC0000X, 207UN0901X, 208000000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076395Medicaid
MO207188707Medicaid
287612OtherPERSONAL CARE
1586875OtherUNITED HEALTHCARE
IL0107OtherJOHN DEERE HEALTH PLAN
IL05732036OtherBLUE SHIELD GROUP NUMBER
38443OtherPHCS
03607639501OtherOSF HEALTH PLANS
IL009824OtherHEALTH ALLIANCE PROVIDER
296074OtherHEALTHLINK
287612OtherPERSONAL CARE
38443OtherPHCS
P00183936Medicare PIN