Healthcare Provider Details

I. General information

NPI: 1417536293
Provider Name (Legal Business Name): LAKSHMI TATINENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALTERS ST
LAKE CHARLES LA
70607-4647
US

IV. Provider business mailing address

PO BOX 122108 DEPT 2108
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 373-480-8066
  • Fax: 337-480-8109
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

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 Number343462
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: