Provider Demographics
NPI:1407841760
Name:LALLA, SUNIL N (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:N
Last Name:LALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14171 METROPOLIS AVE
Mailing Address - Street 2:202
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4335
Mailing Address - Country:US
Mailing Address - Phone:239-561-2202
Mailing Address - Fax:239-561-3099
Practice Address - Street 1:14171 METROPOLIS AVE
Practice Address - Street 2:202
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4335
Practice Address - Country:US
Practice Address - Phone:239-561-2202
Practice Address - Fax:239-561-3099
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME061581207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370308800Medicaid
FL15080OtherBCBS
FLK2813Medicare UPIN
FL370308800Medicaid
FLE62532Medicare UPIN
FL0110242241Medicare NSC