Provider Demographics
NPI:1861454019
Name:MURTHY, KESHAVA (MD)
Entity Type:Individual
Prefix:DR
First Name:KESHAVA
Middle Name:
Last Name:MURTHY
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 1:2555 LINCOLN HWY
Mailing Address - Street 2:SUITE NUMBER 205A
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1936
Mailing Address - Country:US
Mailing Address - Phone:708-747-5615
Mailing Address - Fax:708-747-2317
Practice Address - Street 1:2555 LINCOLN HWY
Practice Address - Street 2:SUITE NUMBER 205A
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1936
Practice Address - Country:US
Practice Address - Phone:708-747-5615
Practice Address - Fax:708-747-2317
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15848Medicare UPIN