Provider Demographics
NPI:1124009576
Name:VALLURI, LALITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:
Last Name:VALLURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2971
Mailing Address - Country:US
Mailing Address - Phone:765-742-1567
Mailing Address - Fax:765-742-2750
Practice Address - Street 1:2316 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2971
Practice Address - Country:US
Practice Address - Phone:765-742-1567
Practice Address - Fax:765-742-2750
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053607A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11330984OtherCAQH
000000345300OtherANTHEM
IN200496230AMedicaid
IN170710KMedicare ID - Type Unspecified
IN200496230AMedicaid