Healthcare Provider Details

I. General information

NPI: 1194164764
Provider Name (Legal Business Name): INDU PRASADH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 AL HIGHWAY 75 N
ALBERTVILLE AL
35951-3838
US

IV. Provider business mailing address

460 AL HIGHWAY 75 N
ALBERTVILLE AL
35951-3838
US

V. Phone/Fax

Practice location:
  • Phone: 256-891-0300
  • Fax: 256-891-0300
Mailing address:
  • Phone: 256-891-0300
  • Fax: 256-891-7461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number270782
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23272
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36702
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: