Provider Demographics
NPI:1205867967
Name:AVULA, RAMESH BABU (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:BABU
Last Name:AVULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 HARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7378
Mailing Address - Country:US
Mailing Address - Phone:517-333-0973
Mailing Address - Fax:
Practice Address - Street 1:1515 LAKE LANSING RD
Practice Address - Street 2:G-1
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3753
Practice Address - Country:US
Practice Address - Phone:517-484-3966
Practice Address - Fax:517-484-9279
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRA056534207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103255569Medicaid
MIG30183Medicare UPIN
MIOM27090Medicare ID - Type Unspecified