Individual
DEVI JAYANTHI MIKKILINENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 PENNSYLVANIA AVE, SUITE 408, DES MOINES, IA 50316-2350
(515) 263-5000
(515) 263-5001
Mailing address
1301 PENNSYLVANIA AVE, SUITE 408, DES MOINES, IA 50316-2350
(515) 263-5000
(515) 263-5001
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
29038
IA
2084P0804X
Child & Adolescent Psychiatry Physician
29038
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689845554
—
IA
01
—
29038
LICENSE
IA
01
—
P00821968
RR MEDICARE
IA
Enumeration date
03/18/2008
Last updated
11/03/2011
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