Provider Demographics
NPI:1629263553
Name:PRASAD, ANIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
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:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0369
Mailing Address - Country:US
Mailing Address - Phone:337-255-6589
Mailing Address - Fax:
Practice Address - Street 1:1425 FREMAUX AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3150
Practice Address - Country:US
Practice Address - Phone:985-643-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022071204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1658839Medicaid
LA1658839Medicaid
LA5W170Medicare PIN