Provider Demographics
NPI:1568545077
Name:HANASOGE, LAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:
Last Name:HANASOGE
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 1:15555 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1896
Mailing Address - Country:US
Mailing Address - Phone:734-285-3090
Mailing Address - Fax:734-285-3095
Practice Address - Street 1:15555 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1896
Practice Address - Country:US
Practice Address - Phone:734-285-3090
Practice Address - Fax:734-285-3095
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4310172903208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILH072903OtherBLUE CROSS MI LICENSE
MI000000000943OtherCAPE HEALTH PLAN
MI4492610Medicaid
MIB43221OtherHA
MI023843OtherMIDWEST HEALTH PLAN
MI16298OtherMCARE