Provider Demographics
NPI:1245251255
Name:ATTALURI, JAYALAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:JAYALAKSHMI
Middle Name:
Last Name:ATTALURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 N KELLOGG ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2875
Mailing Address - Country:US
Mailing Address - Phone:309-345-0394
Mailing Address - Fax:309-345-0130
Practice Address - Street 1:765 N KELLOGG ST
Practice Address - Street 2:SUITE 205
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2875
Practice Address - Country:US
Practice Address - Phone:309-345-0394
Practice Address - Fax:309-345-0130
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360741532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215059OtherBCBS PPO
IL035977OtherHEALTH ALLIANCE
IL260044754OtherMEDICARE RAILROAD
IL0360741531Medicaid
IL472292OtherHEALTHLINK
IL7215059OtherBCBS PPO
ILF37181Medicare UPIN