Provider Demographics
NPI:1235240540
Name:YEKKIRALA, LALITHA (MD)
Entity Type:Individual
Prefix:
First Name:LALITHA
Middle Name:
Last Name:YEKKIRALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-366-1326
Mailing Address - Fax:217-366-6106
Practice Address - Street 1:1400 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2334
Practice Address - Country:US
Practice Address - Phone:217-337-2073
Practice Address - Fax:217-366-6106
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
300025539OtherTRICARE
610234OtherHEALTHLINK, INC.
2159428OtherUNITED HEALTHCARE
7388481OtherAETNA
8553891001OtherCIGNA HEALTHCARE
IL036104792OtherSTATE LICENSE NUMBER
110248524OtherRAILROAD MEDICARE
IL01032021OtherBLUE CROSS BLUE SHIELD
IL036104792Medicaid
IL01032021OtherBLUE CROSS BLUE SHIELD
204485Medicare ID - Type Unspecified