Provider Demographics
NPI:1366471021
Name:BHOGINENI, LALITHA (MD)
Entity Type:Individual
Prefix:
First Name:LALITHA
Middle Name:
Last Name:BHOGINENI
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 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 TOWN CENTER DR STE 209
Practice Address - Street 2:BEAUMONT CIVIC CENTER INTERNAL MEDICINE
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1744
Practice Address - Country:US
Practice Address - Phone:248-585-8340
Practice Address - Fax:248-585-8341
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H07995Medicare UPIN
0M99240004Medicare ID - Type Unspecified