Provider Demographics
NPI:1336150804
Name:LAKHANI, VIPUL TULSI (MD)
Entity Type:Individual
Prefix:DR
First Name:VIPUL
Middle Name:TULSI
Last Name:LAKHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-746-0046
Mailing Address - Fax:541-684-3074
Practice Address - Street 1:1007 HARLOW RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7124
Practice Address - Country:US
Practice Address - Phone:541-746-0046
Practice Address - Fax:541-746-0113
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD167789207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500674749Medicaid
R176680Medicare PIN