Provider Demographics
NPI:1750356226
Name:JUJJAVARAPU, VIJAYA LAKSHMI (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:LAKSHMI
Last Name:JUJJAVARAPU
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 1:1506 W GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-1755
Mailing Address - Country:US
Mailing Address - Phone:309-697-2416
Mailing Address - Fax:309-697-2749
Practice Address - Street 1:1506 W GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-1755
Practice Address - Country:US
Practice Address - Phone:309-698-2416
Practice Address - Fax:309-697-2749
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096534Medicaid
ILG58903Medicare UPIN