Healthcare Provider Details

I. General information

NPI: 1073993358
Provider Name (Legal Business Name): KAVYA MORAVINENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E PENNSYLVANIA AVE
PEORIA IL
61603-3089
US

IV. Provider business mailing address

200 E PENNSYLVANIA AVE
PEORIA IL
61603-3089
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-4000
  • Fax: 309-624-4010
Mailing address:
  • Phone: 309-624-4000
  • Fax: 309-624-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036149627
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: