Provider Demographics
NPI:1982654554
Name:JAGADISH, LALITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:
Last Name:JAGADISH
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:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-0646
Mailing Address - Country:US
Mailing Address - Phone:817-293-4800
Mailing Address - Fax:
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:SUITE201
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7012
Practice Address - Country:US
Practice Address - Phone:817-293-4800
Practice Address - Fax:817-293-4808
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08S582001OtherBCBS
TXH47539Medicare UPIN
TXH08S582001OtherBCBS