Provider Demographics
NPI:1780823211
Name:LAKSHMINARAYANA, PRADEEP HESARAGHATTA (M D)
Entity Type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:HESARAGHATTA
Last Name:LAKSHMINARAYANA
Suffix:
Gender:M
Credentials:M D
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Mailing Address - Street 1:2200 JEFFERSON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 MACK RD STE 120
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5335
Practice Address - Country:US
Practice Address - Phone:513-682-6975
Practice Address - Fax:513-682-6976
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.137868207RP1001X
CT052518207R00000X
IAMD-42511207RP1001X
OH35130666207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine