Individual
MICHAEL LALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1025 MICHIGAN AVE, STE 215, LOGANSPORT, IN 46947-1594
(574) 753-2222
(547) 753-0522
Mailing address
1025 MICHIGAN AVE, STE 215, LOGANSPORT, IN 46947-1594
(574) 753-2222
(547) 753-0522
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01068050
IN
208600000X
Surgery Physician
66204
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000804353
ANTHEM
IN
05
—
201130990
—
IN
Enumeration date
11/14/2008
Last updated
12/08/2015
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