Provider Demographics
NPI:1447360672
Name:CHALLA, LYLA S (MD)
Entity type:Individual
Prefix:
First Name:LYLA
Middle Name:S
Last Name:CHALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4201 GARTH RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3156
Mailing Address - Country:US
Mailing Address - Phone:281-427-0765
Mailing Address - Fax:281-420-8922
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:SUITE 305
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3156
Practice Address - Country:US
Practice Address - Phone:281-427-0765
Practice Address - Fax:281-420-8922
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG4271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130787804Medicaid
TX130787805Medicaid
E36538Medicare UPIN