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NPI Code Detail

MEDICARE: LAKSHMI GULLAPALLI MD

MEDICARE: LAKSHMI GULLAPALLI 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
12085R0202XDiagnostic Radiology Physician01048356AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000363639OTHERINBC BS

General Provider Information

NPI Number : 1164421863
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKSHMI GULLAPALLI MD
Provider Business Mailing Address
First Line : PO BOX 753
Second Line :
City : GOSHEN
State : IN
Zip : 46527-0753
Country : US
Telephone Number : 937-323-5400
Fax Number :
Provider Business Practice Location Address
First Line : 200 HIGH PARK AVE
Second Line :
City : GOSHEN
State : IN
Zip : 46526-4810
Country : US
Telephone Number : 574-533-2141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 07/08/2007

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Directions to “ LAKSHMI GULLAPALLI MD” Practice Location

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