Basic Information
| Provider Information | |||||||||
| NPI: | 1366522245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAKSHMINARAYAN | ||||||||
| FirstName: | KAMAKSHI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LAKSHMINARAYANAN | ||||||||
| OtherFirstName: | KAMAKSI | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 420 DELAWARE ST SE MMC 295 | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126263004 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 516 DELAWARE ST SE | ||||||||
| Address2: | PWB FIRST FLOOR, CLINIC 1A | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126263004 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 10/26/2012 | ||||||||
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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 | 2084N0400X | 42678 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 155408 | 01 | MN | FAIRVIEW | OTHER | 05-00009 | 01 | MN | MEDICA-PRIMARY | OTHER | 319742500 | 05 | MN | MEDICAID | 1031480 | 01 | MN | PREFERRED ONE | OTHER | 142279 | 01 | MN | U CARE | OTHER | 1692245 | 01 | ARAZ | OTHER | 05-00253 | 01 | MN | MEDICA-CHOICE | OTHER | HP37200 | 01 | MN | HEALTH PARTNERS | OTHER |