Individual
DR. PHANICHARAN ADITYA SISTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 36TH AVE, MOLINE, IL 61265-7127
(309) 743-6700
Mailing address
1100 36TH AVE, MOLINE, IL 61265-7127
(309) 743-6700
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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