Provider Demographics
NPI:1376667337
Name:PRASAD, ANIL S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:S
Last Name:PRASAD
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 1:5659 BREEZE BAY DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-8986
Mailing Address - Country:US
Mailing Address - Phone:419-882-6545
Mailing Address - Fax:
Practice Address - Street 1:10501 TELEGRAPH RD
Practice Address - Street 2:SUITE #101
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3375
Practice Address - Country:US
Practice Address - Phone:313-295-7200
Practice Address - Fax:313-295-0009
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087082208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice