Provider Demographics
NPI:1538162805
Name:LAKSHMIN, GURUSAMI M (MD)
Entity type:Individual
Prefix:DR
First Name:GURUSAMI
Middle Name:M
Last Name:LAKSHMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 CARE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4489
Mailing Address - Country:US
Mailing Address - Phone:850-878-8235
Mailing Address - Fax:850-219-2395
Practice Address - Street 1:2626 CARE DR
Practice Address - Street 2:STE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4489
Practice Address - Country:US
Practice Address - Phone:850-878-8235
Practice Address - Fax:850-219-2395
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62021COtherBCBS PROVIDER INDIVIDUAL
FL99039OtherBCBS GROUP NUMBER
FL057914900Medicaid
FLD57284Medicare UPIN
FL99039OtherBCBS GROUP NUMBER