Provider Demographics
NPI:1982816922
Name:LALL, RAJESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:LALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAJESH
Other - Middle Name:
Other - Last Name:POLAVARAPU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3647 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4106
Mailing Address - Country:US
Mailing Address - Phone:863-646-5000
Mailing Address - Fax:863-646-5001
Practice Address - Street 1:3647 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4106
Practice Address - Country:US
Practice Address - Phone:863-646-5000
Practice Address - Fax:863-646-5001
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107070207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease