Provider Demographics
NPI:1487639746
Name:PRASAD, RAKESH NO MIDDLE NAME (MD)
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:NO MIDDLE NAME
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 1:3330 NW 56TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4479
Mailing Address - Country:US
Mailing Address - Phone:405-604-0688
Mailing Address - Fax:405-604-0689
Practice Address - Street 1:3330 NW 56TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4479
Practice Address - Country:US
Practice Address - Phone:405-604-0688
Practice Address - Fax:405-604-0689
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK247301002Medicare ID - Type Unspecified
OKG27562Medicare UPIN