Provider Demographics
NPI:1679660096
Name:MISHRA, PRADIP K (MD)
Entity Type:Individual
Prefix:
First Name:PRADIP
Middle Name:K
Last Name:MISHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:647 DUNLOP LN STE 200
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5165
Mailing Address - Country:US
Mailing Address - Phone:931-920-0228
Mailing Address - Fax:931-920-2191
Practice Address - Street 1:647 DUNLOP LN STE 200
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5165
Practice Address - Country:US
Practice Address - Phone:931-648-0064
Practice Address - Fax:931-553-4215
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN29165207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN29165OtherLICENSE
TN1517323Medicaid
TN3119169Medicaid
TN3119169Medicaid
TN1517323Medicaid