MEDICARE: DR. MEENA MURUGAPPAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2005015799	MO
2	207RP1001X	Pulmonary Disease Physician	036127822	IL
3	207RP1001X	Pulmonary Disease Physician	2010003414	MO

General Provider Information

NPI Number	:	1093924037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEENA MURUGAPPAN M.D.

Provider Business Mailing Address
First Line	:	180 S 3RD ST
Second Line	:	SUITE 103
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-1952
Country	:	US
Telephone Number	:	618-624-5800
Fax Number	:	618-624-5825

Provider Business Practice Location Address
First Line	:	222 S WOODS MILL RD STE 310N
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3627
Country	:	US
Telephone Number	:	314-682-3630
Fax Number	:	314-682-3647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	03/07/2019

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