Provider Demographics
NPI:1750487153
Name:MACHERLA, MURALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MURALI
Middle Name:
Last Name:MACHERLA
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:PO BOX 5877
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5877
Mailing Address - Country:US
Mailing Address - Phone:510-679-3980
Mailing Address - Fax:510-679-3980
Practice Address - Street 1:13640 N 99TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2867
Practice Address - Country:US
Practice Address - Phone:602-999-9999
Practice Address - Fax:480-393-1970
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006026943208G00000X
AZ36680208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCSKQOtherSUN HEALTH GROUP #
AZ219431Medicaid
AZZ115446Medicare PIN
AZI64887Medicare UPIN