Provider Demographics
NPI:1679500623
Name:KRISHNAMURTHI, LAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:
Last Name:KRISHNAMURTHI
Suffix:
Gender:F
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 383285
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-3285
Mailing Address - Country:US
Mailing Address - Phone:901-386-7570
Mailing Address - Fax:901-386-7573
Practice Address - Street 1:4913 RALEIGH COMMON DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128
Practice Address - Country:US
Practice Address - Phone:901-386-7870
Practice Address - Fax:901-386-7573
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34456207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3854935Medicaid
TN4046785OtherBLUE CROSS
TN4046785OtherBC/BS PROV ID#
TN34456OtherSTATE MEDICAL LIC#
TN3854932Medicaid
TN3854932Medicaid
TN3854932Medicare PIN
TN34456OtherSTATE MEDICAL LIC#
TN4046785OtherBLUE CROSS
TN4046785OtherBC/BS PROV ID#