Provider Demographics
NPI:1730111436
Name:PRABHU, SURESH GOPALAKRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:GOPALAKRISHNA
Last Name:PRABHU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7100 SMOKE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8383
Mailing Address - Country:US
Mailing Address - Phone:702-545-0751
Mailing Address - Fax:702-818-4817
Practice Address - Street 1:7100 SMOKE RANCH RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8383
Practice Address - Country:US
Practice Address - Phone:702-545-0751
Practice Address - Fax:702-818-4817
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine