Individual
PURANDATH LALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10080 SW INNOVATION WAY STE 201, PORT ST LUCIE, FL 34987-2129
(772) 344-3811
(772) 344-3890
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-5646
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
125959
FL
2086S0129X
Vascular Surgery Physician
47964
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020817900
—
FL
05
—
182855000
—
MN
01
—
W81GM
FLORIDA BLUE
FL
Enumeration date
02/01/2006
Last updated
10/14/2020
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