| Suresh Krishnamoorthy Md Sc | |
|
1054 M L King Dr Suite 126 Centralia IL 62801-3000 | |
| (618) 533-5500 | |
| (618) 533-5501 |
| Full Name | Suresh Krishnamoorthy Md Sc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1054 M L King Dr, Centralia, Illinois |
| Authorized Official Name and Position | Suresh Krishnamoorthy (PHYSICIAN) |
| Authorized Official Contact | 6185335500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suresh Krishnamoorthy Md Sc 1054 M L King Dr Suite 126 Centralia IL 62801-3000 Ph: (618) 533-5500 | Suresh Krishnamoorthy Md Sc 1054 M L King Dr Suite 126 Centralia IL 62801-3000 Ph: (618) 533-5500 |
| NPI Number | 1912101163 |
|---|---|
| Provider Enumeration Date | 06/12/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1456328012 |
|---|---|
| Medicare Enrollment ID | O20040913001287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912101163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (Illinois) | Primary |
| Provider Name | Suresh Krishnamoorthy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760440580 PECOS PAC ID: 5496722050 Enrollment ID: I20040915000491 |
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