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NPI Code Detail

MEDICARE: ILLIANA INTERNAL MEDICINE, L.L.C.

MEDICARE: ILLIANA INTERNAL MEDICINE, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center0104962AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11265521058OTHERINNPI RAVI KODURU,MD
21174612931OTHERINNPI VUPPALA V REDDY MD
31093804874OTHERINNPI DIPEN SHAH MD
41497844278OTHERINNPI KOSHY OOMMEN MD

General Provider Information

NPI Number : 1003962549
Entity Type Code : Organization
Provider Name (Legal Business Name) : ILLIANA INTERNAL MEDICINE, L.L.C.
Provider Business Mailing Address
First Line : 1332 N 7TH ST
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47807-1004
Country : US
Telephone Number : 812-478-8888
Fax Number : 812-478-1114
Provider Business Practice Location Address
First Line : 1332 N 7TH ST
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47807-1004
Country : US
Telephone Number : 812-478-8888
Fax Number : 812-478-1114
Authorized Official
Title or Position : SENIOR PARTNER
Name : DR. VUPPALA V REDDY
Credential : M.D.
Telephone Number : 812-478-8888
Provider Enumeration Date : 01/26/2007
Last Update Date : 09/14/2007

Similar Medicare Providers

1174612931 — DR. VUPPALA VENKAT REDDY M.D.
Practice Location Address:
1332 N 7TH ST
TERRE HAUTE, IN
47807-1004
Practice Phone: 812-478-8888
Practice Fax: 812-478-1114
1265521058 — DR. RAVI K KODURU M.D.
Practice Location Address:
1332 N 7TH ST
TERRE HAUTE, IN
47807-1004
Practice Phone: 812-478-8888
Practice Fax: 812-478-1114
1093804874 — DR. DIPEN V SHAH M.D.
Practice Location Address:
1332 N 7TH ST
TERRE HAUTE, IN
47807-1004
Practice Phone: 812-478-8888
Practice Fax: 812-478-1114
1336634591 — ANOKA SAVIA MARTIS MD
Practice Location Address:
1332 N 7TH ST
TERRE HAUTE, IN
47807-1004
Practice Phone: 812-478-8888
Practice Fax:
1134930027 — SYDNEY ROSE JOLLIFF FNP-C
Practice Location Address:
1332 N 7TH ST
TERRE HAUTE, IN
47807-1004
Practice Phone: 812-238-7000
Practice Fax:
1720952591 — HAILEY MARVEL
Practice Location Address:
1332 N 7TH ST
TERRE HAUTE, IN
47807-1004
Practice Phone: 812-478-8888
Practice Fax:

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