Healthcare Provider Details

I. General information

NPI: 1952300642
Provider Name (Legal Business Name): LAKSHMAIAH POLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7255 OLD OAK BLVD SUITE C412
MIDDLEBURG HEIGHTS OH
44130-3329
US

IV. Provider business mailing address

7255 OLD OAK BLVD SUITE C412
MIDDLEBURG HEIGHTS OH
44130-3329
US

V. Phone/Fax

Practice location:
  • Phone: 440-816-4546
  • Fax: 440-816-4549
Mailing address:
  • Phone: 440-816-4546
  • Fax: 440-816-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35040398
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: