Healthcare Provider Details

I. General information

NPI: 1407128994
Provider Name (Legal Business Name): L BHANDARU MD & S BHANDARU MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 LASKEY ROAD
TOLEDO OH
43613
US

IV. Provider business mailing address

2230 W LASKEY RD
TOLEDO OH
43613-3543
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. LAKSHMANRAO BHANDARU
Title or Position: PRESIDENT
Credential: M.D
Phone: 419-474-5401