Provider Demographics
NPI:1316688427
Name:ILLA, NIKHIL RAO (MD)
Entity type:Individual
Prefix:DR
First Name:NIKHIL
Middle Name:RAO
Last Name:ILLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:GROUND SILVERSTEIN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-6305
Mailing Address - Fax:215-662-3953
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:GROUND SILVERSTEIN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-6305
Practice Address - Fax:215-662-3953
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD485966208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine