Provider Demographics
NPI:1689694929
Name:LAKRA, YASH P (MD)
Entity Type:Individual
Prefix:DR
First Name:YASH
Middle Name:P
Last Name:LAKRA
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 1:4129 GOLF RIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1728
Mailing Address - Country:US
Mailing Address - Phone:248-855-1247
Mailing Address - Fax:
Practice Address - Street 1:4129 GOLF RIDGE DR E
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1728
Practice Address - Country:US
Practice Address - Phone:248-855-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIYL032210208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C2555OtherMCARE
0206312361OtherBCBS
MI1361132Medicaid
3636200Medicare ID - Type Unspecified
B43458Medicare UPIN