Provider Demographics
NPI:1073992343
Name:KALLUR, LAKSHMI SOUJANYA (MD)
Entity Type:Individual
Prefix:MS
First Name:LAKSHMI
Middle Name:SOUJANYA
Last Name:KALLUR
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 1:915 TATE BLVD SE STE 182
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4042
Mailing Address - Country:US
Mailing Address - Phone:828-322-2005
Mailing Address - Fax:
Practice Address - Street 1:915 TATE BLVD SE STE 182
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4042
Practice Address - Country:US
Practice Address - Phone:828-322-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-00071207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease