Provider Demographics
NPI:1205883832
Name:KOYA, LAXMI DEEPIKA (MD,)
Entity type:Individual
Prefix:
First Name:LAXMI DEEPIKA
Middle Name:
Last Name:KOYA
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 YUCCA DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2743
Mailing Address - Country:US
Mailing Address - Phone:214-888-0670
Mailing Address - Fax:469-299-9080
Practice Address - Street 1:118 LYNN AVE STE 500
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3705
Practice Address - Country:US
Practice Address - Phone:214-888-0670
Practice Address - Fax:469-299-9080
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105793207R00000X, 207RG0100X
TXP0746207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC225704Medicaid
I24042Medicare UPIN
SC225704Medicaid
SCAA07558165Medicare ID - Type Unspecified