Healthcare Provider Details

I. General information

NPI: 1598732398
Provider Name (Legal Business Name): MURALIDHARA RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE (FAHEY BLDG., RM. 222)
MAYWOOD IL
60153
US

IV. Provider business mailing address

2160 S 1ST AVE (FAHEY BLDG., RM. 222)
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-3750
  • Fax: 708-216-6840
Mailing address:
  • Phone: 708-216-3750
  • Fax: 708-216-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number036097182
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number036097182
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36097182
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: