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General NPI Number Information
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NPI Number | 1922205681
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Entity Type | Individual
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Provider Name | AMRUTH R PALLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 4500 CAMPUS RIDGE DR
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City | MIDLAND
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State | MI
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Zip | 48670-8489
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Country | US
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Telephone | 989-839-6188
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Fax | 989-839-6221
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Provider Business Mailing Address
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Address Line | 410 ARBOR VITAE LN
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City | DE PERE
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State | WI
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Zip | 54115-8489
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 2015030942
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 72774
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 72774
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License Number State | WI
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