Provider Demographics
NPI:1043629157
Name:VENKATA DASARI LAKSHMI, KRISHNA VARDHAN (MD)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:VARDHAN
Last Name:VENKATA DASARI LAKSHMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KRISHNA
Other - Middle Name:VARDHAN REDDY
Other - Last Name:VENKATA DASARI LAKSHMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:2055 E SOUTH BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2002
Practice Address - Country:US
Practice Address - Phone:334-747-7575
Practice Address - Fax:334-747-7590
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.36127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine