Provider Demographics
NPI:1669630265
Name:PRABHUKHOT, RUPALI J
Entity Type:Individual
Prefix:DR
First Name:RUPALI
Middle Name:J
Last Name:PRABHUKHOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 MERIT DR.
Mailing Address - Street 2:STE 1500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2202
Mailing Address - Country:US
Mailing Address - Phone:214-217-1991
Mailing Address - Fax:214-217-1912
Practice Address - Street 1:12221 MERIT DR.
Practice Address - Street 2:STE 1500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2202
Practice Address - Country:US
Practice Address - Phone:214-217-1991
Practice Address - Fax:214-217-1912
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2011-01055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program