Provider Demographics
NPI:1144217746
Name:PENDYALA, LAKSHMANA K (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMANA
Middle Name:K
Last Name:PENDYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 HIGHLANDER POINT DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9465
Mailing Address - Country:US
Mailing Address - Phone:812-542-4921
Mailing Address - Fax:812-949-5966
Practice Address - Street 1:41 QUATERMASTER COURT
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3623
Practice Address - Country:US
Practice Address - Phone:812-282-1617
Practice Address - Fax:812-288-7628
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42288207RC0000X, 207RC0000X
IN01066037A207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200940910Medicaid
IN200940910Medicaid
KYP400026101Medicare Oscar/Certification
GA93BDVTSMedicare ID - Type Unspecified