Provider Demographics
NPI:1023070042
Name:PRABHU, PRAMOD V (MD)
Entity type:Individual
Prefix:DR
First Name:PRAMOD
Middle Name:V
Last Name:PRABHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:906 S HEBRON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-4079
Mailing Address - Country:US
Mailing Address - Phone:812-476-1367
Mailing Address - Fax:812-477-4153
Practice Address - Street 1:1401 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2784
Practice Address - Country:US
Practice Address - Phone:270-827-0255
Practice Address - Fax:270-826-5342
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN010398352085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64283179Medicaid
IN838350LMedicare ID - Type Unspecified
KY64283179Medicaid
KY0204604Medicare ID - Type Unspecified
IN211730LMedicare ID - Type Unspecified