Healthcare Provider Details

I. General information

NPI: 1033196738
Provider Name (Legal Business Name): LAKSHMANRAO BHANDARU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 W SYLVANIA AVE STE 105
TOLEDO OH
43613-4147
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FL
TOLEDO OH
43604-7102
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-5401
  • Fax: 419-475-6172
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35045158
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: