Provider Demographics
NPI:1164682597
Name:VENUGOPAL, LEKSHMI R (MD)
Entity Type:Individual
Prefix:DR
First Name:LEKSHMI
Middle Name:R
Last Name:VENUGOPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 E MAIN ST STE M
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2487
Mailing Address - Country:US
Mailing Address - Phone:630-646-5200
Mailing Address - Fax:630-377-3762
Practice Address - Street 1:3805 E MAIN ST STE M
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2487
Practice Address - Country:US
Practice Address - Phone:630-646-5200
Practice Address - Fax:630-377-3762
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1181802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2220936OtherBCBS
IL036118180 1Medicaid
IL036118180 1Medicaid
IL2220936OtherBCBS