Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125.067767 | IL |
N | 111NI0900X | Internist | 125.067767 | IL |
Y | 207R00000X | Internist | 17983 | NV |
Y | 111NI0900X | Internist | 17983 | NV |
N | 207RH0002X | Hospice and Palliative Medicine | 17983 | NV |
NPI | 1215319629 |
---|---|
Provider Name | Dr. Alexander Keerthi Mylavarapu |
First Address | Reno, NV 89502-2055 |
Second Address | Reno, NV 89502-1339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 03/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17983 | NEVADA STATE BOARD OF MEDICAL EXAMINERS (01) | NV |