Healthcare Provider Details

I. General information

NPI: 1316900442
Provider Name (Legal Business Name): PRABHAKARA S HEGGUNJE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W COLUMBIA ST
EVANSVILLE IN
47710-1656
US

IV. Provider business mailing address

415 W COLUMBIA ST
EVANSVILLE IN
47710-1656
US

V. Phone/Fax

Practice location:
  • Phone: 812-464-0521
  • Fax: 812-464-0565
Mailing address:
  • Phone: 812-464-0521
  • Fax: 812-464-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01059515A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: