MEDICARE: LAKSHMAIAH POLA 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	207RG0100X	Gastroenterology Physician	35040398	OH

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	:	1952300642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKSHMAIAH POLA MD

Provider Business Mailing Address
First Line	:	7255 OLD OAK BLVD
Second Line	:	SUITE C412
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3329
Country	:	US
Telephone Number	:	440-816-4546
Fax Number	:	440-816-4549

Provider Business Practice Location Address
First Line	:	7255 OLD OAK BLVD
Second Line	:	SUITE C412
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3329
Country	:	US
Telephone Number	:	440-816-4546
Fax Number	:	440-816-4549

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/23/2015

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