MEDICARE: MANJESHWAR RAMAKRISHNA PRABHU 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	2084P0800X	Psychiatry Physician	G7307	TX

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	:	1659439230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANJESHWAR RAMAKRISHNA PRABHU MD

Provider Business Mailing Address
First Line	:	1147 BRITTMOORE RD, SUITE 4
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-8103
Country	:	US
Telephone Number	:	713-960-0344
Fax Number	:	713-871-9517

Provider Business Practice Location Address
First Line	:	1147 BRITTMOORE RD STE 4
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-5039
Country	:	US
Telephone Number	:	713-960-0344
Fax Number	:	713-871-9517

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	10/08/2021

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