Healthcare Provider Details

I. General information

NPI: 1871584318
Provider Name (Legal Business Name): PRAKASH G MAHALINGASHETTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 HOSPITAL DR SUITE 106
SOUTH WILLIAMSON KY
41503-4095
US

IV. Provider business mailing address

306 HOSPITAL DR SUITE 106
SOUTH WILLIAMSON KY
41503-4095
US

V. Phone/Fax

Practice location:
  • Phone: 606-237-1129
  • Fax: 606-237-0331
Mailing address:
  • Phone: 606-237-1129
  • Fax: 606-237-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20904
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19423
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: