Provider Demographics
NPI:1700847969
Name:PRASAD, VENKAT L (MDMBA/MHA)
Entity Type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:L
Last Name:PRASAD
Suffix:
Gender:M
Credentials:MDMBA/MHA
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2757
Mailing Address - Fax:239-772-0186
Practice Address - Street 1:9800 S HEALTHPARK DR STE 350
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3630
Practice Address - Country:US
Practice Address - Phone:239-343-6008
Practice Address - Fax:239-343-6254
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009801451207Q00000X
FLME133342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891171TMedicaid
FL021626800Medicaid
2262031Medicare PIN
NC2262031BMedicare PIN