Provider Demographics
NPI:1871652065
Name:PRASAD, VIKRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:
Last Name:PRASAD
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 1:775 SOUTH GRAND AVE
Mailing Address - Street 2:PO BOX 768
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-0768
Mailing Address - Country:US
Mailing Address - Phone:517-223-7800
Mailing Address - Fax:517-223-7814
Practice Address - Street 1:775 SOUTH GRAND AVE
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-0768
Practice Address - Country:US
Practice Address - Phone:517-223-7800
Practice Address - Fax:517-223-7814
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0104700202OtherBCBS
MI2861537Medicaid
MIF28202Medicare UPIN
MI2861537Medicaid