Provider Demographics
NPI:1164429403
Name:PRASAD, PRAVEEN CHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:CHANDRA
Last Name:PRASAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 73RD ST STE 17
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-1321
Mailing Address - Country:US
Mailing Address - Phone:515-223-2383
Mailing Address - Fax:515-225-8679
Practice Address - Street 1:1000 73RD ST STE 17
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-1321
Practice Address - Country:US
Practice Address - Phone:515-223-2383
Practice Address - Fax:515-225-8679
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30165208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1118091Medicaid
IA1118091Medicaid
IAF95551Medicare UPIN