Provider Demographics
NPI:1215915483
Name:MURUGAIAN, JAYALAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:JAYALAKSHMI
Middle Name:
Last Name:MURUGAIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 W RIDGEWAY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4544
Mailing Address - Country:US
Mailing Address - Phone:319-833-5888
Mailing Address - Fax:319-833-5891
Practice Address - Street 1:1753 W RIDGEWAY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4544
Practice Address - Country:US
Practice Address - Phone:319-833-5888
Practice Address - Fax:319-833-5891
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1173427Medicaid
IA1215915483Medicaid
IA080171192OtherRR MEDICARE
IA1173427Medicaid
IA1215915483Medicaid