Basic Information
| Provider Information | |||||||||
| NPI: | 1053361337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAKSHMAN | ||||||||
| FirstName: | SANKAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8905 BARTLETT LN | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379228086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654708380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 850 RIVERVIEW RD | ||||||||
| Address2: | |||||||||
| City: | PINEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409771430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765237938 | ||||||||
| FaxNumber: | 2765237028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 09/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 12386 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 4009445 | 05 | TN | MEDICAID |