Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301037985 | MI |
NPI | 1013021278 |
---|---|
Provider Name | Dr. Lakshmi Kottamasu |
First Address | Saginaw, MI 48602-4727 |
Second Address | Saginaw, MA 48602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 27/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4385049 | (05) | MI |
B43697 | (02) | MI |