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NPI Code Detail

MEDICARE: PRAKASH GIDDALURI MD, MPH

MEDICARE: PRAKASH GIDDALURI MD, MPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianPHY TEMPTX
2207Q00000XFamily Medicine PhysicianN0788TX
3207Q00000XFamily Medicine Physician324787LA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18L0266OTHERTXMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164603478
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRAKASH GIDDALURI MD, MPH
Provider Business Mailing Address
First Line : 1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number : 318-212-3520
Fax Number : 318-212-3525
Provider Business Practice Location Address
First Line : 1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number : 318-212-3520
Fax Number : 318-212-3525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2007
Last Update Date : 11/08/2022

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