Provider Demographics
NPI:1689955304
Name:MURARKA, ANISHA MOHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANISHA
Middle Name:MOHAN
Last Name:MURARKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S STATE ST APT 1013
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1657
Mailing Address - Country:US
Mailing Address - Phone:832-265-6117
Mailing Address - Fax:
Practice Address - Street 1:4600 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4038
Practice Address - Country:US
Practice Address - Phone:773-376-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273681223G0001X
IL019.0288511223G0001X
IN12012075A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283698001Medicaid
TX283968003Medicaid
TX283968002Medicaid