Provider Demographics
NPI:1255860979
Name:LAKSHUMANAN, SARAVANASUNDARAM (MD)
Entity Type:Individual
Prefix:
First Name:SARAVANASUNDARAM
Middle Name:
Last Name:LAKSHUMANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SARAVANA
Other - Middle Name:
Other - Last Name:LAKSHUMANAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16110 8TH AVE SW STE A2
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2962
Mailing Address - Country:US
Mailing Address - Phone:206-242-8280
Mailing Address - Fax:206-242-8302
Practice Address - Street 1:16110 8TH AVE SW STE A2
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2962
Practice Address - Country:US
Practice Address - Phone:206-242-8280
Practice Address - Fax:206-242-8302
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMDY61127526207R00000X
WAMD61127526207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2175512Medicaid