Provider Demographics
NPI:1053379735
Name:PADALA, LAKSHMI NARAYANA (MD)
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:NARAYANA
Last Name:PADALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2063 N LECANTO HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9675
Mailing Address - Country:US
Mailing Address - Phone:352-436-4428
Mailing Address - Fax:352-228-4903
Practice Address - Street 1:2063 N LECANTO HWY STE 1
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9675
Practice Address - Country:US
Practice Address - Phone:352-436-4428
Practice Address - Fax:352-228-4903
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71548207Q00000X
FLME 112493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014495300Medicaid
0-627-417-9OtherECFMG
FL14L2TOtherBCBS
FLGH982AMedicare PIN
7124828OtherAETNA
04-2297845OtherPHCS/MULTI-PLAN
04-2297845OtherHCVM/FIRST HEALTH/COVENTRY
1053379735OtherFALLON
0-627-417-9OtherECFMG
AA145632OtherHARVARD PILGRIM
04-2297845OtherUNITED HEALTH CARE
0438633OtherCIGNA
I53671Medicare UPIN
MAPTAN001092001Medicare PIN