Healthcare Provider Details

I. General information

NPI: 1407192131
Provider Name (Legal Business Name): LAKSHMI NAVEEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5669 DELMAR BLVD
SAINT LOUIS MO
63112
US

IV. Provider business mailing address

11703 TARRYTOWN DR
CREVE COEUR MO
63141-8211
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-1770
  • Fax:
Mailing address:
  • Phone: 314-442-6717
  • Fax: 636-333-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2012042471
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2012042471
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: