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General NPI Number Information
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NPI Number | 1114911609
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Entity Type | Organization
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Legal Business Name | SUNIL N LALLA MD PA
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Dates
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Enumeration Date | 09/11/2005
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 14171 METROPOLIS AVE 202
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City | FORT MYERS
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State | FL
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Zip | 33912-4335
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Country | US
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Telephone | 239-561-2202
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Fax | 239-561-3099
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Provider Business Mailing Address
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Address Line | 14171 METROPOLIS AVE 202
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City | FORT MYERS
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State | FL
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Zip | 33912-4335
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Country | US
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Telephone | 239-561-2202
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Fax | 239-561-3099
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUNIL N LALLA
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Credential | M.D., P.A
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Telephone | 239-561-2202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME061581
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License Number State | FL
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