Mukund P Deoras, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

036053626 Issued in IL

Practice address

3333 N Seminary St
Galesburg, IL 61401-1251

Phone

(309) 344-3161

NPI assigned

May 19, 2006

Reactivated

Jun 23, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bloomington Medical Laboratory Physicians, S.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • Bloomington, IL
  • NPI 1841229507
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305158400000",
    "number": "1982657904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9518",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616129518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 N SEMINARY ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011251",
            "telephone_number": "309-344-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEORAS",
        "first_name": "MUKUND",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2011-05-12",
        "deactivation_date": "2010-03-25",
        "reactivation_date": "2010-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036053626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360536262",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily L Dechow, APN
• Deco Inc.
• Sharon K. Degroot, RN
• Jessica Dejaynes, CRNA
• Dental Group of Galesburg PLLC
• Sandra Deppe, LMT
• Alivia Renea Derham, APN
• Nathan Curtis Dieckow, O.D.
• Karley Divan, MA, LPC
• Andre DO, PHARMD

• Anatomic Pathology & Clinical Pathology Physician in Galesburg, IL
• Providers in Galesburg, IL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.