Provider Demographics
NPI:1669411310
Name:SARVEPALLI, PRAKASH (MD)
Entity type:Individual
Prefix:
First Name:PRAKASH
Middle Name:
Last Name:SARVEPALLI
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 1:1021 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EDMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48829-9737
Mailing Address - Country:US
Mailing Address - Phone:989-427-5320
Mailing Address - Fax:989-427-8220
Practice Address - Street 1:1021 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829-9737
Practice Address - Country:US
Practice Address - Phone:989-427-5320
Practice Address - Fax:989-427-8220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1105900141OtherBCBSM
MI4482015OtherMOLINA
MI4482015-10Medicaid
MI0983229OtherHEALTHPLUS COMMERCIAL
MI200000005866OtherPHP COMMERCIAL
MI1007287OtherMCLAREN
MI4606201-10Medicaid
MI1007287OtherMCLAREN
MIG566092Medicare UPIN
MIN89090001Medicare PIN