Provider Demographics
NPI:1518983345
Name:MENEZES, LAKSHMI AVULA (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:AVULA
Last Name:MENEZES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAKSHMI
Other - Middle Name:AVULA
Other - Last Name:RADHAKRISHNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:1942 HIGHLAND OAKS BLVD STE A
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7410
Practice Address - Country:US
Practice Address - Phone:813-670-0035
Practice Address - Fax:813-377-1693
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01194865OtherRR MCR
I17227Medicare UPIN
FLU3358ZMedicare ID - Type Unspecified