Provider Demographics
NPI:1023109444
Name:PRABHAKAR, GANGA (MD)
Entity type:Individual
Prefix:DR
First Name:GANGA
Middle Name:
Last Name:PRABHAKAR
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 1:5880 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8209
Mailing Address - Country:US
Mailing Address - Phone:515-633-3835
Mailing Address - Fax:515-633-3838
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE 250
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-235-5000
Practice Address - Fax:515-288-6713
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036148898208G00000X
WV19367208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1804141000Medicaid
H20701Medicare UPIN
WVPR6029611Medicare ID - Type Unspecified