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General NPI Number Information
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NPI Number | 1134339203
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Entity Type | Individual
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Provider Name | SURESH ALLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 400 JOHN DEERE RD BLDG 2
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City | MOLINE
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State | IL
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Zip | 61265-6898
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Country | US
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Telephone | 309-517-3036
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Fax | 309-797-1088
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Provider Business Mailing Address
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Address Line | 420 NE GLEN OAK AVE STE 401
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City | PEORIA
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State | IL
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Zip | 61603-3112
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Country | US
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Telephone | 309-676-8123
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Fax | 309-676-8455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0005X
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Taxonomy Name | Hypertension Specialist Physician
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License Number | 036130043
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RH0005X
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Taxonomy Name | Hypertension Specialist Physician
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License Number | 40128
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 40128
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036130043
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License Number State | IL
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