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General NPI Number Information
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NPI Number | 1942486774
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Entity Type | Organization
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Legal Business Name | MADHAVA T PALLY MD PA
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 228 PLAZA DR
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-6054
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Country | US
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Telephone | 239-303-9550
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Fax | 239-303-9551
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Provider Business Mailing Address
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Address Line | 228 PLAZA DR
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-6054
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Country | US
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Telephone | 239-303-9550
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Fax | 239-303-9551
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Authorized Official
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Title or Position | OWNER
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Name | DR. MADHAVA T. PALLY
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Credential | M.D.
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Telephone | 239-303-9550
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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 | ME42506
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | ME42506
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME42506
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License Number State | FL
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