Provider Demographics
NPI:1275641326
Name:BOLLA, LEELA R (MD)
Entity Type:Individual
Prefix:
First Name:LEELA
Middle Name:R
Last Name:BOLLA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1890 SW HEALTH PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0421
Mailing Address - Country:US
Mailing Address - Phone:239-597-0544
Mailing Address - Fax:239-597-8644
Practice Address - Street 1:1890 SW HEALTH PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0421
Practice Address - Country:US
Practice Address - Phone:239-597-0544
Practice Address - Fax:239-597-8644
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2010-03-19
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Provider Licenses
StateLicense IDTaxonomies
FLME79879207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD97973Medicare UPIN