Provider Demographics
NPI:1043763261
Name:SUNIL AYYAGARI MD PLLC
Entity type:Organization
Organization Name:SUNIL AYYAGARI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AYYAGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-472-6669
Mailing Address - Street 1:824 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3081
Mailing Address - Country:US
Mailing Address - Phone:309-472-6669
Mailing Address - Fax:
Practice Address - Street 1:824 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3081
Practice Address - Country:US
Practice Address - Phone:309-472-6669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty