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General NPI Number Information
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NPI Number | 1447011267
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Entity Type | Organization
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Legal Business Name | EMERALD MEDICAL PRACTICE, P.C.
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 801 ADLAI STEVENSON DR
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City | SPRINGFIELD
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State | IL
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Zip | 62703-4261
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Country | US
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Telephone | 307-840-9834
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 UTE BLVD STE 370
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City | PARK CITY
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State | UT
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Zip | 84098-7630
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Country | US
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Telephone | 307-840-9834
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ASHWIN MURALIDHARAN
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Credential |
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Telephone | 307-840-9834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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