Provider Demographics
NPI:1467424812
Name:PRABHAKAR, MEENAKSHI (MD)
Entity Type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:
Last Name:PRABHAKAR
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:PO BOX 802772
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-2772
Mailing Address - Country:US
Mailing Address - Phone:972-484-7700
Mailing Address - Fax:972-484-7718
Practice Address - Street 1:2636 TIBBETS DR STE 110
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6919
Practice Address - Country:US
Practice Address - Phone:817-858-0065
Practice Address - Fax:817-283-5520
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3401207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG73684Medicare UPIN
TX8420N0Medicare ID - Type Unspecified