Provider Demographics
NPI:1184735300
Name:LAL, ANUP (MD)
Entity type:Individual
Prefix:
First Name:ANUP
Middle Name:
Last Name:LAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1231 PINE GROVE AVE
Mailing Address - Street 2:STE 2F
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3500
Mailing Address - Country:US
Mailing Address - Phone:810-982-5200
Mailing Address - Fax:810-982-9776
Practice Address - Street 1:1231 PINE GROVE AVE
Practice Address - Street 2:STE 2F
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3500
Practice Address - Country:US
Practice Address - Phone:810-982-5200
Practice Address - Fax:810-982-9776
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070625207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110G410290OtherBCN
140144OtherCARE CHOICES
4443801OtherCIGNA
MI1107410481OtherBCBSM
I24051OtherHAP
MI4694741110Medicaid
P00193753Medicare ID - Type UnspecifiedRAILROAD
M97040003Medicare ID - Type Unspecified
4443801OtherCIGNA