Basic Information
| Provider Information | |||||||||
| NPI: | 1518303585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERRABELLI | ||||||||
| FirstName: | APTA | ||||||||
| MiddleName: | RAO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 E TAMPA ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658061131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178310150 | ||||||||
| FaxNumber: | 7247738370 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 E TAMPA ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658061131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178310150 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2013 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD458579 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2018030701 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2018030701 | 01 | MO | MISSOURI LICENSE | OTHER |