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NPI Code Detail

MEDICARE: DR. RAMAKRISHNA MADALA M.D.

MEDICARE: DR. RAMAKRISHNA MADALA M.D.
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
1207L00000XAnesthesiology PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1187256OTHERILHEALTHLINK UPIN NUMBER
2085972OTHERILHEALTH ALLIANCE NUMBER
308415040OTHERILBLUE CROSS BLUE SHIELD
4L031806OTHERILCHAMPUS/TRICARE
5104409OTHERILHEALTHLINK GROUP NUMBER
632490OTHERILPERSONAL CARE

General Provider Information

NPI Number : 1699763433
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAMAKRISHNA MADALA M.D.
Provider Business Mailing Address
First Line : 800 EAST CARPENTER ST
Second Line : ROOM 2K64
City : SPRINGFIELD
State : IL
Zip : 62769-0001
Country : US
Telephone Number : 217-525-5643
Fax Number : 217-544-2521
Provider Business Practice Location Address
First Line : 800 EAST CARPENTER ST
Second Line : ROOM 2K64
City : SPRINGFIELD
State : IL
Zip : 62769-0001
Country : US
Telephone Number : 217-525-5643
Fax Number : 217-544-2521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 07/09/2007

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