Individual
MADHULIKA LALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8332
(920) 926-8370
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0087838
MD
208M00000X
Hospitalist Physician
0101235949
VA
208M00000X
Hospitalist Physician
60163
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010086272
—
VA
01
—
1000870001
DME PROVIDER
VA
01
—
146132
ANTHEM/BCBS
—
05
—
1821009838
—
VA
01
—
310269
SOUTHERN HEALTH
—
01
—
3810000340
WV MEDICAID
WV
01
—
79389
OPTIMA
VA
01
—
9309526
CIGNA
—
01
—
P00193964
RAILROAD MEDICARE
—
Enumeration date
08/11/2006
Last updated
08/01/2023
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