Provider Demographics
NPI:1164860748
Name:MASODKAR, KANAKLAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:KANAKLAKSHMI
Middle Name:
Last Name:MASODKAR
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 1:3601 4TH ST
Mailing Address - Street 2:STOP 8103
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-0002
Mailing Address - Country:US
Mailing Address - Phone:806-743-2820
Mailing Address - Fax:806-743-4250
Practice Address - Street 1:30 ARDISIA LN
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3881
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-390-7458
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1646012084P0800X
SC405622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty