Individual
JAGAN MOHAN REDDY BOKKA I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-9261
(217) 238-4325
(217) 348-4290
Mailing address
1005 HEALTH CENTER DR STE 201, MATTOON, IL 61938-4693
(217) 238-6055
(217) 348-4290
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-128216
IL
207Q00000X
Family Medicine Physician
26478
OK
208M00000X
Hospitalist Physician
036-128216
IL
Other
Enumeration date
08/12/2008
Last updated
11/13/2018
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