Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | LE055658 | MI |
NPI | 1104890490 |
---|---|
Provider Name | Lokesh R Edara |
First Address | Battle Creek, MI 49017-2331 |
Second Address | Battle Creek, MI 49017-3461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 15/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102640222 | (05) | MI |
B66656 | (02) | MI |