Basic Information
| Provider Information | |||||||||
| NPI: | 1083175681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRASAD | ||||||||
| FirstName: | MAHIMA | ||||||||
| MiddleName: | VENKATESH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VENKATESH | ||||||||
| OtherFirstName: | MAHIMA | ||||||||
| OtherMiddleName: | BALA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3535 OLENTANGY RIVER ROAD GROUND/YELLOW | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145665757 | ||||||||
| FaxNumber: | 6145662338 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 OLENTANGY RIVER ROAD GROUND/YELLOW | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145665757 | ||||||||
| FaxNumber: | 6145662338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | OH | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.