Provider Demographics
NPI:1831176809
Name:AGRAWAL, PREM K (MD, FRCS)
Entity type:Individual
Prefix:
First Name:PREM
Middle Name:K
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:MD, FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 FOXFIRE LN
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7138
Mailing Address - Country:US
Mailing Address - Phone:419-422-3377
Mailing Address - Fax:
Practice Address - Street 1:1400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1304
Practice Address - Country:US
Practice Address - Phone:419-422-5646
Practice Address - Fax:419-422-6040
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-045878208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0506974Medicaid
OH6218555OtherCIGNA
OH000000140324OtherANTHEM BC/BS
OH103455OtherHEALTHPARTNERS
OH1096780001OtherADMINISTAR FEDERAL
OH341849644OtherFEDERAL ID
OH000000168601OtherANTHEM FEDERAL
OH36D0351656OtherCLIA
OH1309147OtherHIGHMARK BC/BS
OH36D0351656OtherCLIA
OH341849644OtherFEDERAL ID
OH103455OtherHEALTHPARTNERS
OHAG0530924Medicare ID - Type Unspecified
OH1096780001Medicare NSC