MEDICARE: PRANAV PRABU MD

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084N0400X	Neurology Physician	DR.0077164	CO

General Provider Information

NPI Number	:	1558001701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRANAV PRABU MD

Provider Business Mailing Address
First Line	:	740 S LIMESTONE ROOM J401
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0293
Country	:	US
Telephone Number	:	859-218-5038
Fax Number	:	859-257-0754

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE ROOM J401
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0293
Country	:	US
Telephone Number	:	859-218-5038
Fax Number	:	859-257-0754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	05/08/2026

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Directions to “ PRANAV PRABU MD” Practice Location

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