Provider Demographics
NPI:1689667594
Name:MUNIYAPPA, PRASANNA K (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASANNA
Middle Name:K
Last Name:MUNIYAPPA
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 1:660 LONDON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1515
Mailing Address - Country:US
Mailing Address - Phone:937-642-1550
Mailing Address - Fax:937-578-2821
Practice Address - Street 1:660 LONDON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1515
Practice Address - Country:US
Practice Address - Phone:937-642-1550
Practice Address - Fax:937-578-2821
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-073558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2185371Medicaid
OH2185371Medicaid
OHMU4020744Medicare ID - Type Unspecified