Provider Demographics
NPI:1922059740
Name:PAPUDESU, BHAGYA LAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAGYA
Middle Name:LAKSHMI
Last Name:PAPUDESU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:502-333-3121
Mailing Address - Fax:502-333-3131
Practice Address - Street 1:8019 DIXIE HWY STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-1303
Practice Address - Country:US
Practice Address - Phone:502-333-3121
Practice Address - Fax:502-333-3131
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA052613207R00000X
KY50072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA052613OtherPROVIDER MEDICAL LICENSE
GA111918OtherFQHC CMS CERT NUMBER
GA111825OtherFQHC CMS CERT NUMBER