Provider Demographics
NPI:1235186958
Name:SUDHA PRASAD M.D.S.C.
Entity Type:Organization
Organization Name:SUDHA PRASAD M.D.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-546-4868
Mailing Address - Street 1:901 S KOKE MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-8012
Mailing Address - Country:US
Mailing Address - Phone:217-546-4868
Mailing Address - Fax:217-698-9286
Practice Address - Street 1:901 S KOKE MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-8012
Practice Address - Country:US
Practice Address - Phone:214-546-4868
Practice Address - Fax:217-698-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL028472OtherHEALTH ALLIANCE
IL08405082OtherBLUECROSS BLUESHIELD
IL114404OtherGHP
IL131837OtherHEALTHLINK
IL=========Medicare UPIN
IL919701Medicare ID - Type Unspecified