Provider Demographics
NPI:1821195355
Name:ADUSUMILLI, PAPARAO (MD)
Entity Type:Individual
Prefix:DR
First Name:PAPARAO
Middle Name:
Last Name:ADUSUMILLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:P
Other - Middle Name:
Other - Last Name:ADUSUMILLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2010 RANCHO LAKE DR UNIT 205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-6477
Mailing Address - Country:US
Mailing Address - Phone:702-653-2112
Mailing Address - Fax:702-653-2832
Practice Address - Street 1:4700 LAS VEGAS BLVD N
Practice Address - Street 2:NELLIS AFB.FEDERAL HOSPITAL.RADIOLOGY DEPT
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-6600
Practice Address - Country:US
Practice Address - Phone:702-653-2112
Practice Address - Fax:702-653-2832
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00TY946Medicaid
TXP00TY946Medicaid
TXE07950Medicare UPIN