Provider Demographics
NPI:1679681043
Name:LALITHA, PARDE YESURATHNAM (MD)
Entity Type:Individual
Prefix:MRS
First Name:PARDE
Middle Name:YESURATHNAM
Last Name:LALITHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PARDE
Other - Middle Name:Y
Other - Last Name:LALITHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1900 EAST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5198
Mailing Address - Country:US
Mailing Address - Phone:217-554-3702
Mailing Address - Fax:217-554-3704
Practice Address - Street 1:1900 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5198
Practice Address - Country:US
Practice Address - Phone:217-554-3702
Practice Address - Fax:217-554-3704
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0603512084N0400X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine