Provider Demographics
NPI:1861455818
Name:NEELAPPA, MALLAPPA (MD)
Entity Type:Individual
Prefix:
First Name:MALLAPPA
Middle Name:
Last Name:NEELAPPA
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:PO BOX 6229
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2510
Mailing Address - Country:US
Mailing Address - Phone:928-344-0810
Mailing Address - Fax:928-726-4186
Practice Address - Street 1:2281 W 24TH ST STE 7
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6197
Practice Address - Country:US
Practice Address - Phone:928-344-0810
Practice Address - Fax:928-726-4186
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32314207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ845076Medicaid
542143127OtherFED TAX ID NUMBER
AZ845076Medicaid
F89598Medicare UPIN
AZ845076Medicaid