Individual
LAVANYA TIRIVEEDHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2115 S FREMONT AVE, SUITE 1000, SPRINGFIELD, MO 65804-2239
(417) 820-8099
(417) 820-8093
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
2007013168
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
# PENDING
AR MEDICAID
AR
01
—
# PENDING
AR BLUE SHIELD
MO
05
—
# PENDING
—
MO
Enumeration date
07/09/2007
Last updated
07/23/2008
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