Basic Information
| Provider Information | |||||||||
| NPI: | 1174730188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEBBEHUNDI MARIGOWDA | ||||||||
| FirstName: | LOKESH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40908 | ||||||||
| Address2: | ATTN. MANAGED CARE PLANNING | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106156949 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1638 OWEN DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106154000 | ||||||||
| FaxNumber: | 9106155681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 03/19/2018 | ||||||||
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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 | 207R00000X | 4301087631 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.