MEDICARE: MR. RAO S MIKKILINENI M.D.

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	207R00000X	Internal Medicine Physician	023852	GA
2	207RP1001X	Pulmonary Disease Physician	023852	GA
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	GA023852	GA
4	207RS0012X	Sleep Medicine (Internal Medicine) Physician	GA023852	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235130808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAO S MIKKILINENI M.D.

Provider Business Mailing Address
First Line	:	483 UPPER RIVERDALE ROAD, SUITE A
Second Line	:	RAI S. MIKKILINENI, M.D.
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2584
Country	:	US
Telephone Number	:	770-991-3888
Fax Number	:	770-994-0278

Provider Business Practice Location Address
First Line	:	483 UPPER RIVERDALE RD SW, SUITE A
Second Line	:	SOUTH ATLANTA PULMONARY & CRITICAL CARE ASS
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2584
Country	:	US
Telephone Number	:	770-991-3888
Fax Number	:	770-994-0278

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/20/2015

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