Provider Demographics
NPI:1104890490
Name:EDARA, LOKESH R (MD)
Entity type:Individual
Prefix:
First Name:LOKESH
Middle Name:R
Last Name:EDARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:49 S CASS ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-2331
Mailing Address - Country:US
Mailing Address - Phone:269-969-8920
Mailing Address - Fax:269-969-8921
Practice Address - Street 1:126 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3461
Practice Address - Country:US
Practice Address - Phone:269-968-3622
Practice Address - Fax:269-968-2103
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MILE055658207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102640222Medicaid
MI102640222Medicaid
MIP14130005Medicare ID - Type Unspecified