Healthcare Provider Details

I. General information

NPI: 1205842242
Provider Name (Legal Business Name): LAKSHMANA RAO AYYAGARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 S LINDEN RD
FLINT MI
48532-3406
US

IV. Provider business mailing address

1165 S LINDEN RD
FLINT MI
48532-3406
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-5400
  • Fax: 810-733-1624
Mailing address:
  • Phone: 810-732-5400
  • Fax: 810-733-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036054745
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301106360
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: