Provider Demographics
NPI:1114909058
Name:PALAKURTHY, PRASAD R (MD)
Entity Type:Individual
Prefix:MR
First Name:PRASAD
Middle Name:R
Last Name:PALAKURTHY
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 1:1301 PENN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2350
Mailing Address - Country:US
Mailing Address - Phone:515-263-2400
Mailing Address - Fax:515-263-2540
Practice Address - Street 1:1301 PENN AVE
Practice Address - Street 2:STE 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2350
Practice Address - Country:US
Practice Address - Phone:515-263-2400
Practice Address - Fax:515-263-2540
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26154207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014459OtherGROUP MISSOURI MEDICARE
IA1114909058Medicaid
IA2043836Medicaid
MO908854459Medicare PIN
IAI6205Medicare ID - Type Unspecified
IAI8659003Medicare PIN
IAC66618Medicare UPIN
IA719260438Medicare PIN