Provider Demographics
NPI:1780070235
Name:MIKKILINENI, SESANK SAI (MD)
Entity type:Individual
Prefix:DR
First Name:SESANK
Middle Name:SAI
Last Name:MIKKILINENI
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 1:3000 TULANE AVE
Mailing Address - Street 2:APT 425
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7292
Mailing Address - Country:US
Mailing Address - Phone:973-722-0428
Mailing Address - Fax:
Practice Address - Street 1:601 PROFESSIONAL DR STE A220
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7698
Practice Address - Country:US
Practice Address - Phone:470-325-1160
Practice Address - Fax:678-701-9860
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR390200000X
GA853862086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program