Provider Demographics
NPI:1225505399
Name:PRESTIGE PRIMARY CARE
Entity Type:Organization
Organization Name:PRESTIGE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAHESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIMMARAYAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:293-676-0656
Mailing Address - Street 1:1855 VETERANS PARK DR STE 304
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0446
Mailing Address - Country:US
Mailing Address - Phone:239-676-0656
Mailing Address - Fax:239-533-9735
Practice Address - Street 1:1855 VETERANS PARK DR STE 304
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0446
Practice Address - Country:US
Practice Address - Phone:239-676-0656
Practice Address - Fax:239-533-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty