Provider Demographics
NPI:1821343922
Name:KRISHNAMOORTHY, MAHALAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:MAHALAKSHMI
Middle Name:
Last Name:KRISHNAMOORTHY
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 1:703 N FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1014
Mailing Address - Country:US
Mailing Address - Phone:954-844-1300
Mailing Address - Fax:954-844-1310
Practice Address - Street 1:703 N FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1014
Practice Address - Country:US
Practice Address - Phone:954-844-1300
Practice Address - Fax:954-844-1310
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123191207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine