Provider Demographics
NPI:1225375199
Name:SATYA-PRAKASH, KANITHAHALLI L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KANITHAHALLI
Middle Name:L
Last Name:SATYA-PRAKASH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SW 10TH STREET
Mailing Address - Street 2:HEMACON LABORATORIES, LLC
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6200
Mailing Address - Country:US
Mailing Address - Phone:352-264-9752
Mailing Address - Fax:
Practice Address - Street 1:106 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6200
Practice Address - Country:US
Practice Address - Phone:352-264-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSU 39577246ZG1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZG1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGeneticist, Medical (PhD)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSU 39577OtherFLORIDA STATE LICENSE