Provider Demographics
NPI:1205965787
Name:LALA, FAISAL (DO)
Entity type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:
Last Name:LALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 ANDREW MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-1166
Mailing Address - Country:US
Mailing Address - Phone:630-290-8903
Mailing Address - Fax:
Practice Address - Street 1:608 N KEY AVE
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-1106
Practice Address - Country:US
Practice Address - Phone:536-821-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117179204R00000X, 207P00000X, 207Q00000X
TXV1523207P00000X
IN02003417A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206813015Medicare PIN