Provider Demographics
NPI:1659316321
Name:ENDOCRINOLOGY CLINIC, PC
Entity Type:Organization
Organization Name:ENDOCRINOLOGY CLINIC, PC
Other - Org Name:LAKSHMI KRISHNAMURTHI, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAMURTHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACE
Authorized Official - Phone:901-757-2345
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0803
Mailing Address - Country:US
Mailing Address - Phone:901-757-2345
Mailing Address - Fax:901-757-9065
Practice Address - Street 1:4913 RALEIGH COMMON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2485
Practice Address - Country:US
Practice Address - Phone:901-386-7870
Practice Address - Fax:901-386-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3854935Medicaid
TNG25680Medicare UPIN
TN3854935Medicare ID - Type Unspecified