Provider Demographics
NPI:1346239597
Name:AKELLA, MOHAN S (MD)
Entity type:Individual
Prefix:
First Name:MOHAN
Middle Name:S
Last Name:AKELLA
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 1:1501 RIDGE CREST CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-1023
Mailing Address - Country:US
Mailing Address - Phone:641-828-7898
Mailing Address - Fax:
Practice Address - Street 1:1501 RIDGE CREST CT
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-1023
Practice Address - Country:US
Practice Address - Phone:641-828-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31716207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG47042Medicare UPIN