{
"Npi": {
"NPI": "1104207984",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MULKAREDDY",
"FirstName": "VINAYA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3 SAINT ELIZABETH BLVD STE 2800",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "O FALLON",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62269-1282",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-233-6044",
"MailingAddressFaxNumber": "833-769-0777",
"FirstLinePracticeLocationAddress": "3 SAINT ELIZABETH BLVD STE 2800",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "O FALLON",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62269-1282",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "618-233-6044",
"PracticeLocationAddressFaxNumber": "833-769-0777",
"EnumerationDate": "06/17/2015",
"LastUpdateDate": "12/21/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "2015017257",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207RC0000X",
"TaxonomyName": "Cardiovascular Disease Physician",
"LicenseNumber": "036.156469",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}