Provider Demographics
NPI:1881814341
Name:LAKSHMIKANTH, BANGALORE NARAYAN (MD)
Entity type:Individual
Prefix:DR
First Name:BANGALORE
Middle Name:NARAYAN
Last Name:LAKSHMIKANTH
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 1:315 JOSE MARTI BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-2868
Mailing Address - Country:US
Mailing Address - Phone:956-544-0401
Mailing Address - Fax:956-542-1643
Practice Address - Street 1:315 JOSE MARTI BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-2868
Practice Address - Country:US
Practice Address - Phone:956-544-0401
Practice Address - Fax:956-542-1643
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4632207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089857901Medicaid
TX0418820001Medicare NSC
TX089857901Medicaid
TXB204207Medicare UPIN