Provider Demographics
NPI:1982808564
Name:SAKTHIVELNATHAN, LAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:SAKTHIVELNATHAN
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 1:800 W RANDOL MILL RD STE 2300
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2504
Mailing Address - Country:US
Mailing Address - Phone:866-202-1032
Mailing Address - Fax:817-548-6649
Practice Address - Street 1:800 W RANDOL MILL RD STE 2300
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:866-202-1032
Practice Address - Fax:817-548-6649
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10026404207R00000X
TXN1118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198872702Medicaid
3886725103OtherMYUTMB 3886725103-COMMERCIAL NUMBER
TX198872703Medicaid
TX8L5169Medicare PIN
TX8L5127Medicare PIN
TX8L5170Medicare PIN