MEDICARE: DR. LEKSHMI R VENUGOPAL 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	2084P0800X	Psychiatry Physician	036-118180	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2220936	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164682597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEKSHMI R VENUGOPAL M.D.

Provider Business Mailing Address
First Line	:	3805 E MAIN ST STE M
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2487
Country	:	US
Telephone Number	:	630-646-5200
Fax Number	:	630-377-3762

Provider Business Practice Location Address
First Line	:	3805 E MAIN ST STE M
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2487
Country	:	US
Telephone Number	:	630-646-5200
Fax Number	:	630-377-3762

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	04/12/2021

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