Provider Demographics
NPI:1891706115
Name:ADUSUMILLI, NARAYANA RAO (MD)
Entity Type:Individual
Prefix:
First Name:NARAYANA
Middle Name:RAO
Last Name:ADUSUMILLI
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 1:600 EAST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251
Mailing Address - Country:US
Mailing Address - Phone:573-592-4100
Mailing Address - Fax:573-592-3023
Practice Address - Street 1:600 EAST 5TH STREET
Practice Address - Street 2:FULTON STATE HOSPITAL
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251
Practice Address - Country:US
Practice Address - Phone:573-592-4100
Practice Address - Fax:573-592-3023
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR4B31207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201541026Medicaid
MO201541026Medicaid
A10181Medicare UPIN
MO073050022Medicare PIN