Individual
DR. PHANICHARAN ADITYA SISTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
255413
MA
207R00000X
Internal Medicine Physician
MD-43414
IA
207RC0000X
Cardiovascular Disease Physician
MD-43414
IA
207RI0011X
Interventional Cardiology Physician
Primary
036.155554
IL
207RI0011X
Interventional Cardiology Physician
MD-43414
IA
208M00000X
Hospitalist Physician
MD-43414
IA
Other
Enumeration date
06/15/2013
Last updated
10/20/2023
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