=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538127949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSANDRA LAL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2006
-----------------------------------------------------
Last Update Date | 11/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2350 N LAKE DRIVE SUITE 304
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-298-7227
-----------------------------------------------------
Fax | 414-298-7229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 788 N JEFFERSON ST SUITE 300/KAAREN BUTZEN
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53202-3718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-272-8950
-----------------------------------------------------
Fax | 414-272-0859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 48299
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------