Provider Demographics
NPI:1801970785
Name:LAL, SUNDER M (MD)
Entity type:Individual
Prefix:DR
First Name:SUNDER
Middle Name:M
Last Name:LAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3062 S OLD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-9547
Mailing Address - Country:US
Mailing Address - Phone:573-445-9290
Mailing Address - Fax:573-303-0140
Practice Address - Street 1:1100 CLUB VILLAGE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4409
Practice Address - Country:US
Practice Address - Phone:573-447-4400
Practice Address - Fax:573-303-0140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR2H47207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202448718Medicaid
0000-91532Medicare ID - Type Unspecified
A13024Medicare UPIN