Provider Demographics
NPI:1134412372
Name:LAKE HIGHLANDS INTERNAL MEDICINE
Entity type:Organization
Organization Name:LAKE HIGHLANDS INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:MEENA
Authorized Official - Last Name:ROYAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-497-6573
Mailing Address - Street 1:6825 TRUXTON DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:SUITE 306
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:214-497-6573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty