Healthcare Provider Details

I. General information

NPI: 1790246098
Provider Name (Legal Business Name): DR. ERALD LULA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 GALLERIA WOODS DR
HOOVER AL
35244-1098
US

IV. Provider business mailing address

3850 GALLERIA WOODS DR
HOOVER AL
35244-1098
US

V. Phone/Fax

Practice location:
  • Phone: 586-804-2075
  • Fax:
Mailing address:
  • Phone: 586-804-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.44788
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: