Provider Demographics
NPI:1578850756
Name:GOLLAPALLI, LAKSHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMAN
Middle Name:
Last Name:GOLLAPALLI
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 1:3195 W RAY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2417
Mailing Address - Country:US
Mailing Address - Phone:480-756-6789
Mailing Address - Fax:480-246-8902
Practice Address - Street 1:3195 W RAY RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2417
Practice Address - Country:US
Practice Address - Phone:480-756-6789
Practice Address - Fax:480-246-8902
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099459207L00000X
ARE-9046207L00000X
AZ58632207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ525676Medicaid
AR211514001Medicaid