Provider Demographics
NPI:1114118247
Name:LALITHA YEKKIRALA MD LTD
Entity Type:Organization
Organization Name:LALITHA YEKKIRALA MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LALITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEKKIRALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-403-1111
Mailing Address - Street 1:2407 S NEIL ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7741
Mailing Address - Country:US
Mailing Address - Phone:217-403-1111
Mailing Address - Fax:217-403-1119
Practice Address - Street 1:2407 S NEIL ST
Practice Address - Street 2:STE 1A
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7741
Practice Address - Country:US
Practice Address - Phone:217-403-1111
Practice Address - Fax:217-403-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-617896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty