Provider Demographics
NPI:1639227853
Name:TADIMETI, LAKSHMINARAYANA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMINARAYANA
Middle Name:
Last Name:TADIMETI
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 1:1801 W ROMNEYA DR STE 504
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1827
Mailing Address - Country:US
Mailing Address - Phone:714-956-3160
Mailing Address - Fax:714-956-0341
Practice Address - Street 1:1801 W ROMNEYA DR STE 504
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1827
Practice Address - Country:US
Practice Address - Phone:714-956-3160
Practice Address - Fax:714-956-0341
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66982207R00000X, 207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0021080Medicaid
CAW10873Medicare ID - Type Unspecified
CAG82617Medicare UPIN