Provider Demographics
NPI:1316910516
Name:RAJAKRISHNAN, DEEPALAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:DEEPALAKSHMI
Middle Name:
Last Name:RAJAKRISHNAN
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 1:11910 GREENVILLE AVE
Mailing Address - Street 2:500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3596
Mailing Address - Country:US
Mailing Address - Phone:214-572-1124
Mailing Address - Fax:
Practice Address - Street 1:11910 GREENVILLE AVE
Practice Address - Street 2:500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3596
Practice Address - Country:US
Practice Address - Phone:214-572-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI18506Medicare UPIN
TX8G1536Medicare ID - Type Unspecified