Individual
SWATHI PULLELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3605
(217) 383-2704
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
036158715
IL
207RN0300X
Nephrology Physician
Primary
03995
KY
207RN0300X
Nephrology Physician
34.012296
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001053047
ANTHEM BCBS
KY
05
—
0179603
—
OH
05
—
7100433230
—
KY
01
—
P01727533
RR MEDICARE
OH
01
—
P01729175
RR MEDICARE
KY
Enumeration date
06/17/2010
Last updated
05/19/2022
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