Provider Demographics
NPI:1679500623
Name:KRISHNAMURTHI, LAKSHMI (MD)
Entity type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:
Last Name:KRISHNAMURTHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3960 NEW COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2504
Practice Address - Country:US
Practice Address - Phone:901-516-5741
Practice Address - Fax:901-516-5986
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34456208M00000X, 207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4046785OtherBLUE CROSS
TN3854935Medicaid
TN3854932Medicaid
TN4046785OtherBC/BS PROV ID#
TN34456OtherSTATE MEDICAL LIC#
TN3854932Medicaid
TN3854932Medicare PIN
TN34456OtherSTATE MEDICAL LIC#
TN4046785OtherBLUE CROSS
TN4046785OtherBC/BS PROV ID#