Boddu, Lavanya

Boddu, Lavanya is an individual health care provider with primary practice located at 2512 Hurst Dr Ste 120 , Mattoon IL 61938-9200. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Boddu, Lavanya can be contacted via phone (217) 258-7590.

Contact Information

Primary practice address
2512 Hurst Dr Ste 120 Mattoon IL 61938-9200
Phone: (217) 258-7590
Fax: (217) 258-3686
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036-121313 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036121313 Illinois

Profile Details

NPI number 1851503833
LBN Legal business name Boddu, Lavanya
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2007
Last updated Dec 30th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851503833 NPPES
Illinois Other 036121313 BLUE SHIELD
Illinois MEDICAID 036121313-1 BLUE SHIELD

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