MEDICARE: MRIDULA PRASAD M.D.

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	2084N0400X	Neurology Physician	01032446	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1578524898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRIDULA PRASAD M.D.

Provider Business Mailing Address
First Line	:	9250 COLUMBIA AVE
Second Line	:	SUITE C1
City	:	MUNSTER
State	:	IN
Zip	:	46321-3538
Country	:	US
Telephone Number	:	219-836-0039
Fax Number	:	219-836-0288

Provider Business Practice Location Address
First Line	:	9250 COLUMBIA AVE
Second Line	:	SUITE C1
City	:	MUNSTER
State	:	IN
Zip	:	46321-3538
Country	:	US
Telephone Number	:	219-836-0039
Fax Number	:	219-836-0288

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	12/08/2011

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