Provider Demographics
NPI:1154462224
Name:ALLA, RAJESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:ALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 NE GLEN OAK AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3112
Mailing Address - Country:US
Mailing Address - Phone:309-676-8123
Mailing Address - Fax:309-676-8455
Practice Address - Street 1:400 JOHN DEERE RD BLDG 2
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6898
Practice Address - Country:US
Practice Address - Phone:309-517-3036
Practice Address - Fax:309-797-1088
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114547207RH0005X
IA36401207RN0300X
IL36114547207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08100343OtherBLUE CROSS BLUE SHIELD
IL1154462224OtherNPI
IL1740349034OtherNPI GROUP
IL0510917Medicaid
IL56266OtherWELLMARK
ILP00650330OtherRAILROAD MEDICARE (HOSP)
IA0175471Medicaid
IL0361145472Medicaid
IL05232009OtherBLUE CROSS BLUE SHIELD
IL93122OtherWELLMARK
ILP00650330OtherRAILROAD MEDICARE (HOSP)
IL1154462224OtherNPI
56266Medicare PIN
ILK39908Medicare PIN
IL08100343OtherBLUE CROSS BLUE SHIELD
IAIB1568Medicare PIN
ILP00424992Medicare PIN
ILI121046Medicare PIN
IL0361145472Medicaid
IL209482Medicare PIN