# DR SHRESTHA MD SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699045740
- **Authorized official:** DR. NIRANJAN SHRESTHA MD, FAAFP (PRESIDENT)
- **Authorized official phone:** (567) 868-4507

## Contact information

- **Practice address:** 1050 M L KING DR, SUITE 111, CENTRALIA, IL 62801-3060
- **Practice address phone:** (567) 868-4507
- **Practice address fax:** (877) 397-7287
- **Mailing address:** 605 SABLE DR, CENTRALIA, IL 62801-4472
- **Mailing address phone:** (567) 868-4507
- **Mailing address fax:** (877) 395-7287

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | IL | Yes |

## Other

- **Enumeration date:** 01/06/2012
- **Last updated:** 01/06/2012