MEDICARE: LAXMI SUKHTANKAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	2901600230	MI

General Provider Information

NPI Number	:	1093368821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAXMI SUKHTANKAR

Provider Business Mailing Address
First Line	:	2019 N LOVINGTON DR APT 103
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-4372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18757 HURON RIVER DR
Second Line	:
City	:	NEW BOSTON
State	:	MI
Zip	:	48164-9357
Country	:	US
Telephone Number	:	734-753-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2019
Last Update Date	:	07/21/2019

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Directions to “ LAXMI SUKHTANKAR ” Practice Location

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