Basic Information
| Provider Information | |||||||||
| NPI: | 1326066101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DODDA | ||||||||
| FirstName: | LAKSHMI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 E 75TH ST | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606493603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739477314 | ||||||||
| FaxNumber: | 7739472487 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 E 75TH ST | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606493603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739477314 | ||||||||
| FaxNumber: | 7739472487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 04/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036-073152 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036-073152 | 05 | IL | MEDICAID |