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General NPI Number Information
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NPI Number | 1265498463
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Entity Type | Organization
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Legal Business Name | SHANMUGAM LAKSHMANAN SC
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 111 E ROGERS ST
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City | SALEM
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State | IL
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Zip | 62881-2902
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Country | US
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Telephone | 618-548-5061
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Fax | 618-568-5079
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Provider Business Mailing Address
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Address Line | 111 E ROGERS ST
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City | SALEM
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State | IL
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Zip | 62881-2902
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Country | US
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Telephone | 618-548-5061
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Fax | 618-568-5079
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHANMUGAM LAKSHMANAN
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Credential | MD
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Telephone | 618-548-5061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | OH2617602
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License Number State | IL
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