Provider Demographics
NPI:1881921344
Name:PRASAD, DEVINA (MD)
Entity type:Individual
Prefix:DR
First Name:DEVINA
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEVINA
Other - Middle Name:
Other - Last Name:MATHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13100 E 136TH ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9417
Practice Address - Country:US
Practice Address - Phone:317-678-3800
Practice Address - Fax:317-678-3830
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075992A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264430618OtherMEDICARE
IN201340520Medicaid
IN100059030OtherMEDICAID GROUP