Organization
MADHAVA T PALLY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MADHAVA T. PALLY M.D. (OWNER)
(239) 303-9550
Entity
Organization
Contact information
Practice address
228 PLAZA DR, LEHIGH ACRES, FL 33936-6054
(239) 303-9550
(239) 303-9551
Mailing address
228 PLAZA DR, LEHIGH ACRES, FL 33936-6054
(239) 303-9550
(239) 303-9551
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME42506
FL
207RC0000X
Cardiovascular Disease Physician
Primary
ME42506
FL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
ME42506
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067609800
—
FL
01
—
1821005422
NPI, INDIVIDUAL
FL
01
—
30597C
MEDICARE, PTAN
FL
Enumeration date
01/10/2008
Last updated
06/22/2015
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