Healthcare Provider Details

I. General information

NPI: 1104075035
Provider Name (Legal Business Name): YASHASWI SRINIVASA MURTHY BELVADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YASHASWI S BELVADI

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 3RD ST
BELLEVILLE IL
62220-1915
US

IV. Provider business mailing address

211 S 3RD ST
BELLEVILLE IL
62220-1915
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-2120
  • Fax: 618-641-5806
Mailing address:
  • Phone: 618-234-2120
  • Fax: 618-641-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number017939
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number93688
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC187627
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036-138611
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: