Individual
NASARAIAH NALLAMOTHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7323 N KNOXVILLE AVE, PEORIA, IL 61614
(217) 528-7541
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036-095726
IL
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
036-095726
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036095726
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036095726
—
IL
01
—
060041893
RAILROAD
IL
Enumeration date
10/19/2006
Last updated
03/14/2025
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