Provider Demographics
NPI:1902846108
Name:PRAKASH, RAHUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:PRAKASH
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 1:411 PARK GROVE LN SUITE 310
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2449
Mailing Address - Country:US
Mailing Address - Phone:713-464-9100
Mailing Address - Fax:713-468-6183
Practice Address - Street 1:411 PARK GROVE LN SUITE 310
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-579-5799
Practice Address - Fax:281-579-5798
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2745207RN0300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113584004Medicaid
TX113584004Medicaid
F15615Medicare UPIN
TX8576B9Medicare ID - Type Unspecified