Individual
MASOOR KAMALESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
503 N MAPLE ST, EFFINGHAM, IL 62401-2006
(217) 342-3700
(217) 342-6286
Mailing address
503 N MAPLE ST, EFFINGHAM, IL 62401-2006
(217) 342-3700
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01054786
IN
207RC0000X
Cardiovascular Disease Physician
Primary
036.101397
IL
207RC0001X
Clinical Cardiac Electrophysiology Physician
01054786A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01054786A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060070329
RAILROAD MEDICARE
IN
05
—
200370980
—
IN
01
—
M47140345
MEDICARE PTAN
IN
Enumeration date
04/17/2006
Last updated
12/28/2021
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