Provider Demographics
NPI:1912917444
Name:VAKIL, PRAFULCHANDRA G (MBBS MD)
Entity Type:Individual
Prefix:
First Name:PRAFULCHANDRA
Middle Name:G
Last Name:VAKIL
Suffix:
Gender:M
Credentials:MBBS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9341 STONEBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:318-429-5710
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024439207L00000X
TXM0955207L00000X
KY39679207L00000X
NM2003-0560207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487503Medicaid
LA4E965F699Medicare ID - Type Unspecified
LA1487503Medicaid