Healthcare Provider Details

I. General information

NPI: 1336141308
Provider Name (Legal Business Name): HANIMIREDDY LAKIREDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 E YOSEMITE AVE SUITE 100
MERCED CA
95340-8219
US

IV. Provider business mailing address

388 E YOSEMITE AVE SUITE 100
MERCED CA
95340-8219
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-3456
  • Fax: 209-722-6084
Mailing address:
  • Phone: 209-383-3456
  • Fax: 209-722-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA39957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: