Healthcare Provider Details

I. General information

NPI: 1154462224
Provider Name (Legal Business Name): RAJESH ALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 JOHN DEERE RD BLDG 2
MOLINE IL
61265-6898
US

IV. Provider business mailing address

420 NE GLEN OAK AVE STE 401
PEORIA IL
61603-3112
US

V. Phone/Fax

Practice location:
  • Phone: 309-517-3036
  • Fax: 309-797-1088
Mailing address:
  • Phone: 309-676-8123
  • Fax: 309-676-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number036114547
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number36401
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number36114547
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: