Provider Demographics
NPI:1548311194
Name:GURURAJAN, KRISHNAMURTHY (MD)
Entity type:Individual
Prefix:
First Name:KRISHNAMURTHY
Middle Name:
Last Name:GURURAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:GURURAJAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:205 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1957
Mailing Address - Country:US
Mailing Address - Phone:847-786-5672
Mailing Address - Fax:
Practice Address - Street 1:205 E PARK ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1957
Practice Address - Country:US
Practice Address - Phone:847-786-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0768952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
786480Medicare ID - Type Unspecified