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General NPI Number Information
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NPI Number | 1144329913
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Entity Type | Individual
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Provider Name | DR. RAJAMANI AVULA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 9330 BROADWAY
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City | CROWN POINT
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State | IN
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Zip | 46307-8602
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Country | US
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Telephone | 800-644-1243
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Fax |
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Provider Business Mailing Address
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Address Line | 2922 CARMEL DR
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2284
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Country | US
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Telephone |
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01051848A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301068556
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20046
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License Number State | WV
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