Provider Demographics
NPI:1659474161
Name:TUKIVAKALA, PRABHAKARA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:PRABHAKARA
Middle Name:REDDY
Last Name:TUKIVAKALA
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 806
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-0806
Mailing Address - Country:US
Mailing Address - Phone:870-338-7441
Mailing Address - Fax:870-338-7945
Practice Address - Street 1:810 NEWMAN DR # A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-8950
Practice Address - Country:US
Practice Address - Phone:870-338-7441
Practice Address - Fax:870-338-7945
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117462001Medicaid
AR53659B386Medicare PIN
AR117462001Medicaid
AR53659OtherBLUE CROSS