MEDICARE: BHEERENDRA RAMANNA 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	207R00000X	Internal Medicine Physician	42139	TN

General Provider Information

NPI Number	:	1831318286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHEERENDRA RAMANNA PRASAD M.D.

Provider Business Mailing Address
First Line	:	3836 PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-6633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3836 PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-6633
Country	:	US
Telephone Number	:	901-324-3984
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	12/06/2007

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