Provider Demographics
NPI:1659385227
Name:PRASAD, NIRAJ KISHORE (MD)
Entity Type:Individual
Prefix:
First Name:NIRAJ
Middle Name:KISHORE
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 1:608 NW 9TH ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1068
Mailing Address - Country:US
Mailing Address - Phone:405-231-3737
Mailing Address - Fax:405-272-6144
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1068
Practice Address - Country:US
Practice Address - Phone:405-231-3737
Practice Address - Fax:405-272-6144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK21035207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100058130AMedicaid
OK100058130AMedicaid
OK100058130AMedicaid