Basic Information
| Provider Information | |||||||||
| NPI: | 1235240540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YEKKIRALA | ||||||||
| FirstName: | LALITHA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618203909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173661326 | ||||||||
| FaxNumber: | 2173666106 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 W PARK ST | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173372073 | ||||||||
| FaxNumber: | 2173666106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036104792 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 300025539 | 01 | TRICARE | OTHER | 610234 | 01 | HEALTHLINK, INC. | OTHER | 2159428 | 01 | UNITED HEALTHCARE | OTHER | 7388481 | 01 | AETNA | OTHER | 8553891001 | 01 | CIGNA HEALTHCARE | OTHER | 036104792 | 01 | IL | STATE LICENSE NUMBER | OTHER | 110248524 | 01 | RAILROAD MEDICARE | OTHER | 01032021 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 036104792 | 05 | IL | MEDICAID |