Provider Demographics
NPI:1104124569
Name:LINGAM, SRISKANTHARAJAH
Entity type:Individual
Prefix:MR
First Name:SRISKANTHARAJAH
Middle Name:
Last Name:LINGAM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SRI
Other - Middle Name:
Other - Last Name:LINGAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:750 N 200 W
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1677
Mailing Address - Country:US
Mailing Address - Phone:801-722-5595
Mailing Address - Fax:
Practice Address - Street 1:750 N 200 W
Practice Address - Street 2:SUITE # 300
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1677
Practice Address - Country:US
Practice Address - Phone:801-722-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator