Healthcare Provider Details

I. General information

NPI: 1558395947
Provider Name (Legal Business Name): MANISH PRASAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S WINTER ST
ADRIAN MI
49221-3876
US

IV. Provider business mailing address

4151 LAKE FOREST CT
ANN ARBOR MI
48108-2769
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-8905
  • Fax:
Mailing address:
  • Phone: 517-263-8905
  • Fax: 517-265-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301079202
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4301079202
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: