Provider Demographics
NPI:1386035301
Name:PRASAD KORLIPARA. M.D.
Entity Type:Organization
Organization Name:PRASAD KORLIPARA. M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJANAYA PRASAD
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:KORLIPARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-489-5900
Mailing Address - Street 1:1331 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4825
Mailing Address - Country:US
Mailing Address - Phone:772-489-5900
Mailing Address - Fax:772-489-2086
Practice Address - Street 1:1331 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4825
Practice Address - Country:US
Practice Address - Phone:772-489-5900
Practice Address - Fax:772-489-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54509207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040773900Medicaid
FL08613Medicare PIN