Basic Information
| Provider Information | |||||||||
| NPI: | 1730130626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISRA | ||||||||
| FirstName: | LALITH | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | DO PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | # L-3652 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432606453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837927 | ||||||||
| FaxNumber: | 7403837942 | ||||||||
| Practice Location | |||||||||
| Address1: | 990 S PROSPECT ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433026283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837910 | ||||||||
| FaxNumber: | 7403758129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 34.007451 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 2056793 | 01 | CIGNA | OTHER | 2205885 | 05 | OH | MEDICAID | 353077 | 01 | SUBMITTER NO | OTHER | 260782000 | 01 | MAGELLAN MIS | OTHER | 311098079 | 01 | TAX ID | OTHER | 000000206898 | 01 | OH | ANTHEM | OTHER | 260047857 | 01 | TRAVELERS MEDICARE | OTHER | 260782000 | 01 | AETNA | OTHER | 311098079 | 01 | PPO NEXT | OTHER | 320201 | 01 | MT CARMEL BEHAVIORAL HEAL | OTHER | 1555037 | 01 | UHC | OTHER |