MEDICARE: DR. LAKSHMANA R MADALA M.D.

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	207L00000X	Anesthesiology Physician	4301037304	MI
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	4301037304	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093742637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAKSHMANA R MADALA M.D.

Provider Business Mailing Address
First Line	:	1119 S WASHINGTON AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2558
Country	:	US
Telephone Number	:	989-752-1900
Fax Number	:	989-752-1901

Provider Business Practice Location Address
First Line	:	1119 S WASHINGTON AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2558
Country	:	US
Telephone Number	:	989-752-1900
Fax Number	:	989-752-1901

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	03/31/2021

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