Provider Demographics
NPI:1114335049
Name:BANDIPALLIAM, PRATHAP (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATHAP
Middle Name:
Last Name:BANDIPALLIAM
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 1:2688 PINK PIGEON PKWY
Mailing Address - Street 2:#225,
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2258
Mailing Address - Country:US
Mailing Address - Phone:646-884-2611
Mailing Address - Fax:
Practice Address - Street 1:2688 PINK PIGEON PKWY
Practice Address - Street 2:225
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2258
Practice Address - Country:US
Practice Address - Phone:646-884-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43267207R00000X
WI40576207R00000X
MI4301067795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine