Provider Demographics
NPI:1689845554
Name:MIKKILINENI, DEVI JAYANTHI (MD)
Entity Type:Individual
Prefix:
First Name:DEVI
Middle Name:JAYANTHI
Last Name:MIKKILINENI
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 1:1301 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2350
Mailing Address - Country:US
Mailing Address - Phone:515-263-5000
Mailing Address - Fax:515-263-5001
Practice Address - Street 1:1301 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2350
Practice Address - Country:US
Practice Address - Phone:515-263-5000
Practice Address - Fax:515-263-5001
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA290382084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1689845554Medicaid
IA29038OtherLICENSE
IAP00821968OtherRR MEDICARE
IAP00821968OtherRR MEDICARE