Provider Demographics
NPI:1225024730
Name:SIRIPURAPU, PRASAD R (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:R
Last Name:SIRIPURAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SIRIPURAPU
Other - Middle Name:R
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8800 S OCEAN DR APT 910
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2147
Mailing Address - Country:US
Mailing Address - Phone:740-632-2024
Mailing Address - Fax:
Practice Address - Street 1:1545 9TH ST SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-4312
Practice Address - Country:US
Practice Address - Phone:772-257-8224
Practice Address - Fax:772-213-3157
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME153379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001479820Medicaid
FLME153379OtherSTATE LICENSE
WV0077486000Medicaid
OH0362816Medicaid