Individual
DR. SURESH KRISHNAMOORTHY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1054 M L KING DR, SUITE 126, CENTRALIA, IL 62801-3000
(618) 533-5500
(618) 533-5501
Mailing address
1054 M L KING DR, SUITE 126, CENTRALIA, IL 62801-3000
(618) 533-5500
(618) 533-5501
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
036091773
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-091773
—
IL
Enumeration date
05/02/2006
Last updated
06/30/2016
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