Provider Demographics
NPI:1588659320
Name:MURUGAPPAN, KADHIRESAN (MD SC)
Entity Type:Individual
Prefix:DR
First Name:KADHIRESAN
Middle Name:
Last Name:MURUGAPPAN
Suffix:
Gender:M
Credentials:MD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MC LEANSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62859-0429
Mailing Address - Country:US
Mailing Address - Phone:618-643-2361
Mailing Address - Fax:618-643-2361
Practice Address - Street 1:611 S MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:MC LEANSBORO
Practice Address - State:IL
Practice Address - Zip Code:62859-1213
Practice Address - Country:US
Practice Address - Phone:618-643-2361
Practice Address - Fax:618-643-2361
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060687Medicaid
GADA7259OtherRAILROAD MEDICARE
IL207175Medicare ID - Type Unspecified
GADA7259OtherRAILROAD MEDICARE