MEDICARE: PRAKASH SARVEPALLI 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	207R00000X	Internal Medicine Physician	4301071121	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1105900141	OTHER	MI	BCBSM
2	4482015	OTHER	MI	MOLINA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0983229	OTHER	MI	HEALTHPLUS COMMERCIAL
5	200000005866	OTHER	MI	PHP COMMERCIAL
6	1007287	OTHER	MI	MCLAREN
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669411310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAKASH SARVEPALLI M.D.

Provider Business Mailing Address
First Line	:	1021 E. MAIN STREET
Second Line	:
City	:	EDMORE
State	:	MI
Zip	:	48829-9737
Country	:	US
Telephone Number	:	989-427-5320
Fax Number	:	989-427-8220

Provider Business Practice Location Address
First Line	:	1021 E. MAIN STREET
Second Line	:
City	:	EDMORE
State	:	MI
Zip	:	48829-9737
Country	:	US
Telephone Number	:	989-427-5320
Fax Number	:	989-427-8220

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/28/2023

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