Healthcare Provider Details

I. General information

NPI: 1508813247
Provider Name (Legal Business Name): LALITHA MADHAV JANAKI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14120 NORTHWEST BLVD
CORPUS CHRISTI TX
78410-5121
US

IV. Provider business mailing address

919 HIDDEN RDG
IRVING TX
75038-3813
US

V. Phone/Fax

Practice location:
  • Phone: 361-241-2626
  • Fax: 361-904-0178
Mailing address:
  • Phone: 469-282-2711
  • Fax: 469-282-0996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberF7794
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberF7794
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: