MEDICARE: LAKSHMI R. BEERAVOLU MD

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	2084N0400X	Neurology Physician	2014029851	MO
2	2084N0600X	Clinical Neurophysiology Physician	2014029851	MO
3	2084N0400X	Neurology Physician	ME129984	FL
4	2084N0600X	Clinical Neurophysiology Physician	036131387	IL

General Provider Information

NPI Number	:	1376745117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKSHMI R. BEERAVOLU MD

Provider Business Mailing Address
First Line	:	4550 MEMORIAL DR
Second Line	:	STE. A480
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5372
Country	:	US
Telephone Number	:	618-234-4531
Fax Number	:	618-234-4695

Provider Business Practice Location Address
First Line	:	4550 MEMORIAL DR
Second Line	:	STE. A480
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5372
Country	:	US
Telephone Number	:	618-234-4531
Fax Number	:	618-234-4695

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	01/15/2026

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