MEDICARE: RAMMOHAN MARLA, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	036134953	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036134953	OTHER	IL	LICENSE

General Provider Information

NPI Number	:	1023402864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMMOHAN MARLA, P.C.

Provider Business Mailing Address
First Line	:	2570 24TH ST
Second Line	:	STE 127
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5394
Country	:	US
Telephone Number	:	309-779-4350
Fax Number	:	309-779-4355

Provider Business Practice Location Address
First Line	:	2570 24TH ST
Second Line	:	STE 127
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5394
Country	:	US
Telephone Number	:	309-779-4350
Fax Number	:	309-779-4355

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAMMOHAN MARLA
Credential	:	MD
Telephone Number	:	563-613-4277

Provider Enumeration Date	:	03/18/2015
Last Update Date	:	03/18/2015

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