Individual
DR. MOHAN BABU PALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1011 BOWLES AVE STE 300, FENTON, MO 63026-2387
(636) 496-5065
Mailing address
2040 ROCHESTER RD, TROY, MI 48083-1837
(310) 426-4415
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036160962
IL
207R00000X
Internal Medicine Physician
D90794
MD
207RC0000X
Cardiovascular Disease Physician
036160962
IL
207RC0000X
Cardiovascular Disease Physician
D90794
MD
207RI0011X
Interventional Cardiology Physician
036160962
IL
207RI0011X
Interventional Cardiology Physician
Primary
2025017659
MO
207RI0011X
Interventional Cardiology Physician
21166
ND
207RI0011X
Interventional Cardiology Physician
D9074
MD
207RI0011X
Interventional Cardiology Physician
PENDING
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2013
Last updated
06/11/2025
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