Healthcare Provider Details

I. General information

NPI: 1609866052
Provider Name (Legal Business Name): HIMA S ATLURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2981 N MAIN ST
DECATUR IL
62526-3259
US

IV. Provider business mailing address

2981 N MAIN ST
DECATUR IL
62526-3259
US

V. Phone/Fax

Practice location:
  • Phone: 217-877-9775
  • Fax: 217-877-9806
Mailing address:
  • Phone: 217-877-9775
  • Fax: 217-877-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036095807
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036095807
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: