Provider Demographics
NPI:1619344272
Name:XOLANI MDLULI,MD,INC., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:XOLANI MDLULI,MD,INC., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XOLANI
Authorized Official - Middle Name:P
Authorized Official - Last Name:MDLULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-539-8672
Mailing Address - Street 1:PO BOX 2644
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2644
Mailing Address - Country:US
Mailing Address - Phone:917-539-8672
Mailing Address - Fax:
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE E218
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:917-539-8672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99214207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA168266Medicare PIN