Healthcare Provider Details

I. General information

NPI: 1124636881
Provider Name (Legal Business Name): LAKSHMI GOPALAKRISHNAN NAIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 WAUBE LN
GREEN BAY WI
54304-5521
US

IV. Provider business mailing address

1400 JACKSON ST
DENVER CO
80206-2762
US

V. Phone/Fax

Practice location:
  • Phone: 920-548-9500
  • Fax: 920-828-9530
Mailing address:
  • Phone: 303-270-2913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0009871
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number85702-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: