Provider Demographics
NPI:1912252461
Name:KANNAN, LAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:KANNAN
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 1:6043 WINTHROP COMMERCE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4274
Mailing Address - Country:US
Mailing Address - Phone:813-291-0629
Mailing Address - Fax:813-515-3018
Practice Address - Street 1:6043 WINTHROP COMMERCE AVE STE 201
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4274
Practice Address - Country:US
Practice Address - Phone:813-291-0629
Practice Address - Fax:813-515-3018
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163735207RE0101X
ALMD.42810207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL270484Medicaid