Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 01083022A | IN |
N | 207RC0200X | Critical Care Medicine | 26406 | WV |
NPI | 1053744367 |
---|---|
Provider Name | Jagadeesh Yella |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46219-3049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2013 |
Last Update Date | 17/10/2019 |