MEDICARE: LAKSHMI KOCHARLA MD

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	207RR0500X	Rheumatology Physician	4301081558	MI

General Provider Information

NPI Number	:	1518178813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKSHMI KOCHARLA MD

Provider Business Mailing Address
First Line	:	5800 FOREMOST DR SE STE 300
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7062
Country	:	US
Telephone Number	:	833-850-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 FOREMOST DR SE STE 202
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7062
Country	:	US
Telephone Number	:	833-850-0888
Fax Number	:

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	11/29/2021

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Directions to “ LAKSHMI KOCHARLA MD” Practice Location

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