Healthcare Provider Details

I. General information

NPI: 1952387953
Provider Name (Legal Business Name): MURALI D. ADUSUMALLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 CREEKSIDE DR
FOLSOM CA
95630-3400
US

IV. Provider business mailing address

3400 DATA DR PHYSICIAN SUPPORT SERVICES
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-986-4426
  • Fax: 916-986-4434
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA84969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: