Provider Demographics
NPI:1528005345
Name:GOPALAKRISHNAN, LAKSHMY (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMY
Middle Name:
Last Name:GOPALAKRISHNAN
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:PO BOX 203257
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-3257
Mailing Address - Country:US
Mailing Address - Phone:281-784-1088
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:211 HIGHLAND CROSS DR
Practice Address - Street 2:SUITE 275
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1733
Practice Address - Country:US
Practice Address - Phone:281-784-1088
Practice Address - Fax:281-784-1555
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3899207R00000X
TXM6635208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528005345OtherBCBS TX
TX197894201Medicaid
TX8BG290OtherBCBSTX PROV NO
TX1528005345OtherTRICARE SOUTH
AR152891001Medicaid
TX8BG290OtherBCBSTX PROV NO
TX1528005345OtherTRICARE SOUTH
AR152891001Medicaid
TX8K9792Medicare PIN
AR5M790Medicare ID - Type Unspecified