Provider Demographics
NPI:1710182829
Name:LAKSHMI K DASARI PC
Entity type:Organization
Organization Name:LAKSHMI K DASARI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAKSHMI K DASAREE MD
Authorized Official - Prefix:
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:K
Authorized Official - Last Name:DASAREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-763-0730
Mailing Address - Street 1:PO BOX 3034
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-3034
Mailing Address - Country:US
Mailing Address - Phone:901-763-0579
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:STE 720B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-763-0730
Practice Address - Fax:901-763-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30076261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
125215000OtherUS DEPT OF LABOR
5010784OtherTLC FAMILY HEALTHCARE
4053624OtherBCBST
000000118233OtherUNISON HEALTHPLAN
228634705OtherTRICARE
AR134469001Medicaid
TN3380512Medicaid
4053624OtherBCBST