Healthcare Provider Details

I. General information

NPI: 1306779467
Provider Name (Legal Business Name): SIREESHA MURALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 CAMPUS DR
JOLIET IL
60435-5128
US

IV. Provider business mailing address

812 CAMPUS DR
JOLIET IL
60435-5128
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-6830
  • Fax:
Mailing address:
  • Phone: 815-741-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number297.011172
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: