Provider Demographics
NPI:1851321244
Name:PRABHU, ASHWIN BASRUR (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHWIN
Middle Name:BASRUR
Last Name:PRABHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:ROOM M53
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-5908
Mailing Address - Fax:859-323-8056
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-5908
Practice Address - Fax:859-323-8056
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP306207P00000X
FLME95742207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I64752Medicare UPIN