Healthcare Provider Details

I. General information

NPI: 1508822206
Provider Name (Legal Business Name): LALITHA K RAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 WEST PERRY ST
TIFFIN OH
44883
US

IV. Provider business mailing address

PO BOX 1108
ANN ARBOR MI
48106-1108
US

V. Phone/Fax

Practice location:
  • Phone: 419-447-9993
  • Fax:
Mailing address:
  • Phone: 734-677-7400
  • Fax: 734-677-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35047808R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: