Healthcare Provider Details

I. General information

NPI: 1942300827
Provider Name (Legal Business Name): INTERNAL MEDICINE PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SIMPSON DR
WINONA MS
38967-3009
US

IV. Provider business mailing address

515 SIMPSON DR
WINONA MS
38967-3009
US

V. Phone/Fax

Practice location:
  • Phone: 662-283-9993
  • Fax: 662-283-4088
Mailing address:
  • Phone: 662-283-9993
  • Fax: 662-283-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GUTTI J RAO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 662-283-9993