Individual
KILALI IYALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
305 W JACKSON ST STE 206, CARBONDALE, IL 62901-1474
(618) 457-3006
(618) 457-3008
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036155596
IL
2086S0102X
Surgical Critical Care Physician
036155596
IL
2086S0127X
Trauma Surgery Physician
Primary
036155596
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/20/2014
Last updated
08/30/2021
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