Provider Demographics
NPI:1427187350
Name:LAKSHMAN, THIRU VENKAT (MD)
Entity Type:Individual
Prefix:DR
First Name:THIRU
Middle Name:VENKAT
Last Name:LAKSHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3722
Mailing Address - Country:US
Mailing Address - Phone:512-418-1979
Mailing Address - Fax:512-418-1943
Practice Address - Street 1:13915 N. MOPAC EXPWY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728
Practice Address - Country:US
Practice Address - Phone:512-418-1979
Practice Address - Fax:512-628-0455
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6906174400000X, 208C00000X
PAMD425598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219790701Medicaid