Provider Demographics
NPI:1588669303
Name:LAKKADI, RAJASHEKAR (MD)
Entity Type:Individual
Prefix:MR
First Name:RAJASHEKAR
Middle Name:
Last Name:LAKKADI
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:PO BOX 2527
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-2527
Mailing Address - Country:US
Mailing Address - Phone:903-331-0506
Mailing Address - Fax:903-331-0462
Practice Address - Street 1:438 N FREDONIA ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6468
Practice Address - Country:US
Practice Address - Phone:903-331-0506
Practice Address - Fax:903-331-0462
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111921174400000X
TXM4849207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2516763OtherUNITED HEALTHCARE #
TX193160201Medicaid
IL2516763OtherUNITED HEALTHCARE #
TX193160201Medicaid
TX193160201Medicaid