Basic Information
| Provider Information | |||||||||
| NPI: | 1295757250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURESH G PRABHU MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 653 N TOWN CENTER DR | ||||||||
| Address2: | 217 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891440514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022563637 | ||||||||
| FaxNumber: | 7022568510 | ||||||||
| Practice Location | |||||||||
| Address1: | 653 N TOWN CENTER DR | ||||||||
| Address2: | 217 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891440514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022563637 | ||||||||
| FaxNumber: | 7022568510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 11/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | PRABHU | ||||||||
| AuthorizedOfficialFirstName: | SURESH | ||||||||
| AuthorizedOfficialMiddleName: | GOPALAKRISHNA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7022563637 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9867 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.