Individual
RAJESH MALLELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
208 CORWIN LN, KOKOMO, IN 46902-6612
(765) 864-8700
(765) 864-8715
Mailing address
6626 E 75TH ST, SUITE 500, INDIANA, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
01055567A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200388170
—
IN
05
—
200388170A
—
IN
01
—
P01824494
RR MEDICARE
IN
Enumeration date
03/08/2006
Last updated
02/11/2020
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