Provider Demographics
NPI:1043211188
Name:DHADPHALE, PRAKASH R (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:R
Last Name:DHADPHALE
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 1:710 CHIPPEWA SQ
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4821
Mailing Address - Country:US
Mailing Address - Phone:906-226-2569
Mailing Address - Fax:906-226-3225
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2705
Practice Address - Country:US
Practice Address - Phone:906-226-2569
Practice Address - Fax:906-226-3225
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPD034430207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1261843Medicaid
MIB46445Medicare UPIN
MI0E26006Medicare ID - Type Unspecified