Provider Demographics
NPI:1053957381
Name:DAVU, LAKSHMI KANTHARAO
Entity type:Individual
Prefix:
First Name:LAKSHMI KANTHARAO
Middle Name:
Last Name:DAVU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2522
Mailing Address - Country:US
Mailing Address - Phone:810-239-9941
Mailing Address - Fax:810-341-6471
Practice Address - Street 1:1200 E BRISTOL RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-2522
Practice Address - Country:US
Practice Address - Phone:810-239-9941
Practice Address - Fax:810-341-6471
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MI53020365751835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer