Individual
DR. KESAVARAO MITTAPALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 PROSPECT AVE, FACULTY PRACTICE OFFICE, HACKENSACK, NJ 07601-1914
(201) 996-2816
Mailing address
280 HENRY ST, PARAMUS, NJ 07652-4536
(201) 261-0262
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA05903900
NJ
Other
Enumeration date
06/03/2006
Last updated
07/08/2007
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