Provider Demographics
NPI:1003962549
Name:ILLIANA INTERNAL MEDICINE, L.L.C.
Entity Type:Organization
Organization Name:ILLIANA INTERNAL MEDICINE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VUPPALA
Authorized Official - Middle Name:V
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-478-8888
Mailing Address - Street 1:1332 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-1004
Mailing Address - Country:US
Mailing Address - Phone:812-478-8888
Mailing Address - Fax:812-478-1114
Practice Address - Street 1:1332 N 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1004
Practice Address - Country:US
Practice Address - Phone:812-478-8888
Practice Address - Fax:812-478-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0104962A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1265521058OtherNPI RAVI KODURU,MD
IN1174612931OtherNPI VUPPALA V REDDY MD
IN1093804874OtherNPI DIPEN SHAH MD
IN1497844278OtherNPI KOSHY OOMMEN MD