MEDICARE: DR. BHAGYA LAKSHMI PAPUDESU 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	207R00000X	Internal Medicine Physician	052613	GA
2	207R00000X	Internal Medicine Physician	50072	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	052613	OTHER	GA	PROVIDER MEDICAL LICENSE
2	111918	OTHER	GA	FQHC CMS CERT NUMBER
3	111825	OTHER	GA	FQHC CMS CERT NUMBER

General Provider Information

NPI Number	:	1922059740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHAGYA LAKSHMI PAPUDESU M.D.

Provider Business Mailing Address
First Line	:	1395 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5710
Country	:	US
Telephone Number	:	502-333-3121
Fax Number	:	502-333-3131

Provider Business Practice Location Address
First Line	:	8019 DIXIE HWY STE 101
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40258-1303
Country	:	US
Telephone Number	:	502-333-3121
Fax Number	:	502-333-3131

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	03/24/2020

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Directions to “ DR. BHAGYA LAKSHMI PAPUDESU M.D.” Practice Location

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