Provider Demographics
NPI:1043384555
Name:PANDRANGI, LAKSHMI V (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:V
Last Name:PANDRANGI
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:24725 E. JEFFERSON
Mailing Address - City:ST. CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080
Mailing Address - Country:US
Mailing Address - Phone:586-774-7800
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:24725 E. JEFFERSON
Practice Address - City:ST. CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080
Practice Address - Country:US
Practice Address - Phone:586-774-7800
Practice Address - Fax:586-771-0730
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI464323210Medicaid
080H262390OtherBLUE CROSS-BLUE CROSS
LP077786OtherCHAMPUS-CHAMPUS
LP077786OtherCOMMERCIAL-COMMERCIAL NUMBER