Healthcare Provider Details

I. General information

NPI: 1386171320
Provider Name (Legal Business Name): LAKSHMI VILASITHA KOCHERLAKOTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18185 N 83RD AVE STE 107
GLENDALE AZ
85308-0520
US

IV. Provider business mailing address

10125 E MEADOW HILL DR
SCOTTSDALE AZ
85260-9215
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-0306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61525
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: