Individual provider · NPI-1

Jagan Mohan Reddy Bokka I, M.D

Family Medicine · Mattoon, IL

NPI number1124274063
StatusActive
Last updated in NPPESNov 13, 2018

Details

NPI
1124274063
Entity type
Individual (NPI-1)
Name
Jagan Mohan Reddy Bokka I
Credential
M.D
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 12, 2008
Last updated
Nov 13, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine036-128216ILYes
207Q00000X Family Medicine26478OK
208M00000X Hospitalist036-128216IL

Practice location

1000 Health Center Dr
Mattoon, IL 61938-9261

Phone 217-238-4325 · Fax 217-348-4290

Mailing address

1005 Health Center Dr Ste 201
Mattoon, IL 61938-4693

Phone 217-238-6055 · Fax 217-348-4290

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