Individual
YOGESH B MALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2831 LONE OAK RD, PADUCAH, KY 42003-8041
(270) 554-8373
(270) 554-8987
Mailing address
2831 LONE OAK RD, PADUCAH, KY 42003-8041
(270) 554-8373
(270) 554-8987
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
38503
KY
208VP0014X
Interventional Pain Medicine Physician
036112552
IL
208VP0014X
Interventional Pain Medicine Physician
Primary
38503
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000338788
BC/BS
KY
05
—
64080393
—
KY
Enumeration date
11/14/2005
Last updated
09/04/2012
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