Provider Demographics
NPI:1013021278
Name:KOTTAMASU, LAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:
Last Name:KOTTAMASU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-6122
Mailing Address - Fax:989-583-2811
Practice Address - Street 1:900 COOPER
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MA
Practice Address - Zip Code:48602
Practice Address - Country:US
Practice Address - Phone:989-583-6122
Practice Address - Fax:989-583-2811
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037985207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4385049Medicaid
MI4385049Medicaid
MIB43697Medicare UPIN