Provider Demographics
NPI:1487689303
Name:ACHANTA, VENKATA LAKSHMI S (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA LAKSHMI
Middle Name:S
Last Name:ACHANTA
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 1:12121 RICHMOND AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2439
Mailing Address - Country:US
Mailing Address - Phone:281-569-4647
Mailing Address - Fax:281-569-4649
Practice Address - Street 1:12121 RICHMOND AVE STE 420
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2439
Practice Address - Country:US
Practice Address - Phone:281-569-4647
Practice Address - Fax:281-569-4649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24899208M00000X
TXM7808208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200058007Medicaid
TX8BG291OtherBCBSTX PROVIDER NO.
TX1487689303OtherTRICARE SOUTH
OK200087190AMedicaid
TXP01205809OtherRAILROAD MCARE
TX1487689303OtherBCBS OF TX
TX200058001Medicaid
OK24899OtherLICENSE
OK34577OtherOBNDD
TXTXB162732Medicare PIN
OK200087190AMedicaid
TX8K9396Medicare PIN
TXTXB119343Medicare PIN
TX200058007Medicaid
TX1487689303OtherTRICARE SOUTH
TXP00783864Medicare PIN