Provider Demographics
NPI:1821099045
Name:PRASAD, PINNAMANENI RAMAKRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:PINNAMANENI
Middle Name:RAMAKRISHNA
Last Name:PRASAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PINNAMANENI
Other - Middle Name:R
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 77000 DEPT 771255
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2000
Mailing Address - Country:US
Mailing Address - Phone:313-271-3000
Mailing Address - Fax:313-271-3003
Practice Address - Street 1:16407 SOUTHFIELD RD
Practice Address - Street 2:STE A
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2571
Practice Address - Country:US
Practice Address - Phone:313-271-3000
Practice Address - Fax:313-271-3003
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036210207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110Q26434OtherBCBS
MI18210990445Medicaid
MI4241568Medicaid
MI120671OtherCARE CHOICES
MI110179431C30371OtherTRAVELERS MEDICARE
MIC5579OtherM-CARE
MI118544OtherGREAT LAKES HEALTH PLAN
MIG02484OtherBLUECARE NETWORK
MI3575OtherCAPE HEALTH PLAN
MI4540391OtherAETNA
MIP99362OtherBLUECARE NETWORK
MI204980OtherFEDERAL BLACK LUNG
MI18210990445Medicaid
0Q26434007Medicare PIN
MIP99362OtherBLUECARE NETWORK