Provider Demographics
NPI:1114175312
Name:KOLAR, PRASHANT (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:
Last Name:KOLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRASHANT
Other - Middle Name:
Other - Last Name:KOLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:612 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6041
Mailing Address - Country:US
Mailing Address - Phone:480-834-9039
Mailing Address - Fax:480-964-7802
Practice Address - Street 1:612 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6041
Practice Address - Country:US
Practice Address - Phone:480-834-9039
Practice Address - Fax:480-964-7802
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1253054038207R00000X
IL036-127849207R00000X
MO2012003456207RN0300X
AZ50486207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03612784901Medicaid
AZ023114Medicaid
AZZ176489Medicare PIN