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General NPI Number Information
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NPI Number | 1407649288
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Entity Type | Individual
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Provider Name | RADHIKA LAKSHMI EDPUGANTI DO
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Gender | Female
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 1 GENESYS PKWY
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City | GRAND BLANC
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State | MI
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Zip | 48439-8065
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Country | US
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Telephone | 507-458-9666
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Fax |
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Provider Business Mailing Address
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Address Line | 555 VIA BELLA CT
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City | HOWEY IN THE HILLS
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State | FL
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Zip | 34737-4344
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Country | US
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Telephone | 507-458-9666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5151017508
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License Number State | MI
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