Provider Demographics
NPI:1336247857
Name:PRASAD, KALPANA K (MD)
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:K
Last Name:PRASAD
Suffix:
Gender:F
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:PO BOX 4147
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760
Mailing Address - Country:US
Mailing Address - Phone:432-332-3400
Mailing Address - Fax:432-332-6500
Practice Address - Street 1:601 E 2ND STREET SUITE A
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-332-3400
Practice Address - Fax:432-332-6500
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153976903Medicaid
TX153976903Medicaid
H71931Medicare UPIN