MEDICARE: LALITHA VEMURI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	4301041572	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073674578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LALITHA VEMURI MD

Provider Business Mailing Address
First Line	:	30645 ROSEMOND DR
Second Line	:
City	:	FRANKLIN
State	:	MI
Zip	:	48025-2134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 W LAWRENCE ST
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48342-2105
Country	:	US
Telephone Number	:	248-858-5326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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