Provider Demographics
NPI:1609800531
Name:MISHRA, PRANAV (MD)
Entity Type:Individual
Prefix:
First Name:PRANAV
Middle Name:
Last Name:MISHRA
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 1397
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0023
Mailing Address - Country:US
Mailing Address - Phone:256-891-1460
Mailing Address - Fax:
Practice Address - Street 1:604 SMITH RD
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-3412
Practice Address - Country:US
Practice Address - Phone:256-891-1460
Practice Address - Fax:256-891-2640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF65190Medicare UPIN