Provider Demographics
NPI:1245216779
Name:PRAKASH, NAGAPPA S (MD)
Entity Type:Individual
Prefix:MR
First Name:NAGAPPA
Middle Name:S
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3815 E BELL RD
Mailing Address - Street 2:3400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2164
Mailing Address - Country:US
Mailing Address - Phone:602-971-2761
Mailing Address - Fax:602-971-1529
Practice Address - Street 1:3815 E BELL RD
Practice Address - Street 2:3400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2164
Practice Address - Country:US
Practice Address - Phone:602-971-2761
Practice Address - Fax:602-971-1529
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2019-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ19925207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ219239Medicaid
E28409Medicare UPIN