Provider Demographics
NPI:1336172303
Name:DEEP, LAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:DEEP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAKSHMI
Other - Middle Name:
Other - Last Name:CHERABUDDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 WESTHILL DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3795
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W10618 CLINIC ST
Practice Address - Street 2:
Practice Address - City:ELCHO
Practice Address - State:WI
Practice Address - Zip Code:54428-9619
Practice Address - Country:US
Practice Address - Phone:715-275-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34080500Medicaid
WI34080500Medicaid