Provider Demographics
NPI:1275735094
Name:IRAGAVARAPU, PRASAD ACHYUTA (MD)
Entity Type:Individual
Prefix:
First Name:PRASAD
Middle Name:ACHYUTA
Last Name:IRAGAVARAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14440 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3720
Mailing Address - Country:US
Mailing Address - Phone:561-498-5800
Mailing Address - Fax:561-496-0148
Practice Address - Street 1:14440 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3720
Practice Address - Country:US
Practice Address - Phone:561-498-5800
Practice Address - Fax:561-496-0148
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61261Medicare ID - Type Unspecified