DR. MURUGAVEL M MUTHUSAMY (NPI# 1467420760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467420760 |
| Entity Type | Individual |
| Full Name | DR. MURUGAVEL M MUTHUSAMY |
| Credential | M.D. |
| Practice Address |
1052 Martin Luther King Dr Ste 100 Centralia IL 62801-3002 |
| Practice Telephone | 6184366479 |
| Practice Fax Number | 6184368032 |
| Mailing Telephone | 6184366479 |
| Mailing Fax Number | 6184368032 |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2020-10-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
36148444 | IL | Allopathic & Osteopathic Physicians |
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
01040972A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | DMERC | 5171410005 | 01 |
| DMERC | 5171410003 | 01 | |
| DMERC | 5171410004 | 01 | |
| IN | 100361800 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2600 Roosevelt Rd, Valparaiso, IN 463830970 | 2194641620 | |
| 1052 Martin Luther King Dr Ste 100, Centralia, IL 628013002 | 6184366479 | 6184368032 |
| Street Address |
1052 MARTIN LUTHER KING DR STE 100 |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801-3002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649831124 | Elena Vagia | Internal Medicine | 233 E Superior St Ste 1-061, Chicago, IL 60611-2913 | 2019-06-25 |
| 1194206367 | Illinois Cancer Specialists | Internal Medicine | 360 Station Dr Ste 201, Crystal Lake, IL 60014-7978 | 2018-08-27 |
| 1861986549 | Quincy Physicians & Surgeons Clinic, Sc | Internal Medicine | 3347 Broadway St, Quincy, IL 62301 | 2018-06-18 |
| 1730634700 | Liyun Huang | Internal Medicine | 17495 South La Grange Rd, Tinley Park, IL 60487 | 2016-08-19 |
| 1578017596 | Mercy Clinic Specialists Services-illinois LLC | Internal Medicine | 2227 Vadalabene Dr Ste 200, Maryville, IL 62062-5824 | 2016-08-08 |
| 1356793319 | Glenda Maria Delgado Ramos | Internal Medicine | 2160 S 1st Ave Ste 167, Maywood, IL 60153-3328 | 2016-07-01 |
| 1023403516 | Meghan Rebecca Steiner | Internal Medicine | 5841 S Maryland Ave # Mc-2115, Chicago, IL 60637 | 2015-04-01 |
| 1700270154 | Joseph Heng | Internal Medicine | 5841 S Maryland Ave # Mc1152, Chicago, IL 60637-1443 | 2015-03-24 |
| 1497148118 | Pinal Chokshi | Internal Medicine | 525 E Congress Pkwy Ste 300, Crystal Lake, IL 60014-6258 | 2015-03-05 |
| 1770998262 | Adventist Bolingbrook Hospital | Internal Medicine | 420 S Schmidt, Ste 230, Bolingbrook, IL 60440 | 2014-06-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.