Healthcare Provider Details

I. General information

NPI: 1275735094
Provider Name (Legal Business Name): PRASAD ACHYUTA IRAGAVARAPU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 MILITARY TRL
DELRAY BEACH FL
33484-3720
US

IV. Provider business mailing address

14440 MILITARY TRL
DELRAY BEACH FL
33484-3720
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-5800
  • Fax: 561-496-0148
Mailing address:
  • Phone: 561-498-5800
  • Fax: 561-496-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME39794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: