Healthcare Provider Details

I. General information

NPI: 1982808564
Provider Name (Legal Business Name): LAKSHMI SAKTHIVELNATHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W RANDOL MILL RD STE 2300
ARLINGTON TX
76012-2504
US

IV. Provider business mailing address

800 W RANDOL MILL RD STE 2300
ARLINGTON TX
76012-2504
US

V. Phone/Fax

Practice location:
  • Phone: 866-202-1032
  • Fax: 817-548-6649
Mailing address:
  • Phone: 866-202-1032
  • Fax: 817-548-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10026404
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN1118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: