MEDICARE: DR. LAVANYA GOPALAKRISHNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME92183	FL
2	207Q00000X	Family Medicine Physician	N2532	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME92183	OTHER	FL	FLORIDA LICENSE NUMBER
3	N2532	OTHER	TX	TEXAS LICENSE

General Provider Information

NPI Number	:	1144259706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAVANYA GOPALAKRISHNAN

Provider Business Mailing Address
First Line	:	809 SINGLETON BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-4014
Country	:	US
Telephone Number	:	214-540-0300
Fax Number	:	214-651-9514

Provider Business Practice Location Address
First Line	:	3111 SYLVAN AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-4028
Country	:	US
Telephone Number	:	214-540-0030
Fax Number	:	214-379-2281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/31/2013

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