Healthcare Provider Details

I. General information

NPI: 1912984139
Provider Name (Legal Business Name): MURALI MAHESWARAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 FALLS AVE STE 202
TWIN FALLS ID
83301-2307
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-9077
  • Fax: 208-814-9081
Mailing address:
  • Phone: 208-381-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberO-2000
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: