Individual
BALA SUDHAKAR REDDY ALLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2600
(417) 820-2100
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2010018938
MO
208M00000X
Hospitalist Physician
Primary
2010018938
MO
390200000X
Student in an Organized Health Care Education/Training Program
MT189901
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104024231
—
MO
05
—
183039001
—
AR
01
—
431560263
TRICARE WEST
—
01
—
P00852017
RAILROAD MEDICARE GROUP CB9013
—
Enumeration date
07/10/2007
Last updated
05/08/2017
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