Provider Demographics
NPI:1407876824
Name:REDDY, LAKSHMI K (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:K
Last Name:REDDY
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 1:21336 PROVINCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7580
Mailing Address - Country:US
Mailing Address - Phone:281-809-0085
Mailing Address - Fax:281-809-0083
Practice Address - Street 1:21336 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7580
Practice Address - Country:US
Practice Address - Phone:281-809-0085
Practice Address - Fax:281-809-0083
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN 5355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A942950Medicaid
TX094010801OtherGROUP MEDICAID
TX00J21AOtherGROUP MEDICARE PIN
TX094010801OtherGROUP MEDICAID
CA00A942951Medicare PIN