Individual
LAKSHMANA RAO AYYAGARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1165 S LINDEN RD, FLINT, MI 48532-3406
(810) 732-5400
(810) 733-1624
Mailing address
1165 S LINDEN RD, FLINT, MI 48532-3406
(810) 732-5400
(810) 733-1624
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036054745
IL
207RC0000X
Cardiovascular Disease Physician
Primary
4301106360
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036054745
MEDICAL LICENSE
ID
01
—
036054745
IPA ID#
IL
01
—
364025739
TAX ID
—
01
—
4301106360
STATE MEDICAL LICENSE
MI
01
—
690280
BCBS GROUP ID#
IL
Enumeration date
07/31/2006
Last updated
03/07/2023
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