Provider Demographics
NPI:1881632388
Name:LAKSHMANAN, YEGAPPAN (MD)
Entity Type:Individual
Prefix:
First Name:YEGAPPAN
Middle Name:
Last Name:LAKSHMANAN
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 1:3901 BEAUBIEN ST
Mailing Address - Street 2:3RD FLR UROLOGY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:3RD FLR UROLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5588
Practice Address - Fax:313-993-8738
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59269208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881632388Medicaid
MI0H27729OtherBCBS OF MI
MD402352800Medicaid
MI0H27729Medicare PIN
MDKS16G458Medicare ID - Type Unspecified
MI1881632388Medicaid