Provider Demographics
NPI:1124256623
Name:RAO S. MIKKILINENI MD, LLC
Entity type:Organization
Organization Name:RAO S. MIKKILINENI MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAO
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIKKILINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-202-6120
Mailing Address - Street 1:391 MARTINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2713
Mailing Address - Country:US
Mailing Address - Phone:908-625-6938
Mailing Address - Fax:973-597-1076
Practice Address - Street 1:391 MARTINSVILLE RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2713
Practice Address - Country:US
Practice Address - Phone:908-625-6938
Practice Address - Fax:973-597-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51744207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ162629Medicare PIN