Provider Demographics
NPI:1588637839
Name:MITTAPALLI, ARUNA K (MD)
Entity Type:Individual
Prefix:
First Name:ARUNA
Middle Name:K
Last Name:MITTAPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10529 ROTHENBURG RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4917
Mailing Address - Country:US
Mailing Address - Phone:630-783-0054
Mailing Address - Fax:
Practice Address - Street 1:10529 ROTHENBURG RD
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4917
Practice Address - Country:US
Practice Address - Phone:630-783-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-084908207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084908Medicaid
IL3932056OtherBLUE SHIELD
IL3932056OtherBLUE SHIELD
IL036084908Medicaid
ILK45061Medicare PIN