Provider Demographics
NPI:1295757250
Name:SURESH G PRABHU MD PC
Entity type:Organization
Organization Name:SURESH G PRABHU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:GOPALAKRISHNA
Authorized Official - Last Name:PRABHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-256-3637
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:217
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-256-3637
Mailing Address - Fax:702-256-8510
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:217
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-256-3637
Practice Address - Fax:702-256-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty