Provider Demographics
NPI:1881650273
Name:MIKKILINENI, RAO S (MD)
Entity Type:Individual
Prefix:
First Name:RAO
Middle Name:S
Last Name:MIKKILINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:391 MARTINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2713
Mailing Address - Country:US
Mailing Address - Phone:908-625-6938
Mailing Address - Fax:973-597-1076
Practice Address - Street 1:377 JERSEY AVE
Practice Address - Street 2:STE 470
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4393
Practice Address - Country:US
Practice Address - Phone:201-918-2239
Practice Address - Fax:201-918-2243
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA51744207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1582208Medicaid
D40653Medicare UPIN
NJ162623ZENFMedicare PIN