Provider Demographics
NPI:1508822206
Name:RAO, LALITHA K
Entity Type:Individual
Prefix:
First Name:LALITHA
Middle Name:K
Last Name:RAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-1108
Mailing Address - Country:US
Mailing Address - Phone:734-677-7400
Mailing Address - Fax:734-677-7400
Practice Address - Street 1:477 WEST PERRY ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:419-447-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047808R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341398058OtherSELECTCARE
OH341398058OtherHEALTHPLUS
OHA15341OtherHEALTH ALLIANCE PLAN
OH0513242Medicaid
751523OtherBUCKEYE - MENTAL HEALTH
OH11656843OtherCAQH
OH000000131477OtherBCBS
OH260003668OtherRR MEDICARE
751523OtherBUCKEYE - MENTAL HEALTH
OH341398058OtherSELECTCARE