Provider Demographics
NPI:1598944571
Name:TENNETI, LAKSHMI VS (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:VS
Last Name:TENNETI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4010
Mailing Address - Fax:512-901-3910
Practice Address - Street 1:1250 S CAPITAL OF TEXAS HWY BLDG 3
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6446
Practice Address - Country:US
Practice Address - Phone:512-901-4010
Practice Address - Fax:512-901-3910
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.090701207R00000X
ARE-6997207RN0300X
TXR9002207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5I056OtherAR BC/BS
AR188916001Medicaid
AR5AM33Medicare PIN
AR188916001Medicaid