1235240540 NPI number — LALITHA YEKKIRALA M.D.

Table of content: LALITHA YEKKIRALA M.D. (NPI 1235240540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235240540 NPI number — LALITHA YEKKIRALA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEKKIRALA
Provider First Name:
LALITHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235240540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 W UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMPAIGN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61820-3909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-366-1326
Provider Business Mailing Address Fax Number:
217-366-6106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 W PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61801-2334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-337-2073
Provider Business Practice Location Address Fax Number:
217-366-6106
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036104792 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300025539 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 610234 . This is a "HEALTHLINK, INC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 2159428 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7388481 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8553891001 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036104792 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 110248524 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01032021 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036104792 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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