Healthcare Provider Details

I. General information

NPI: 1790941227
Provider Name (Legal Business Name): SRILATHA ATLURI LAZZARO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 KOHLER MEMORIAL DR
SHEBOYGAN WI
53081-3129
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-4461
  • Fax: 920-459-1483
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number5497920
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036.121282
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number54979
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: