1124059506 NPI number — ROOP LAL M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124059506 NPI number — ROOP LAL M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LAL

Provider First Name:

ROOP

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1124059506

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/14/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

340 W LINCOLN ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BELLEVILLE

Provider Business Mailing Address State Name:

IL

Provider Business Mailing Address Postal Code:

62220-1900

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

618-233-6044

Provider Business Mailing Address Fax Number:

618-233-3287

Provider First Line Business Practice Location Address:

340 W LINCOLN ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BELLEVILLE

Provider Business Practice Location Address State Name:

IL

Provider Business Practice Location Address Postal Code:

62220-1900

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

618-233-6044

Provider Business Practice Location Address Fax Number:

618-233-3287

Provider Enumeration Date:

07/05/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0001X , with the licence number:  036074237 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0000X , with the licence number: 036-074237 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 16187 . This is a "BCBS MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 42237 . This is a "CMR" identifier . This identifiers is of the category "OTHER".
• Identifier: 2507217 . This is a "SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
• Identifier: C41351 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
• Identifier: 098955 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 12477 . This is a "ESSENCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 236567 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 37099690002 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
• Identifier: 060009695 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0360742371 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
• Identifier: 259513 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
• Identifier: 187709 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".