Healthcare Provider Details

I. General information

NPI: 1235861907
Provider Name (Legal Business Name): JOHN ANGELO PRAKAPAS IV DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2097
US

IV. Provider business mailing address

1012 BURNS ST
DETROIT MI
48214-2861
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-8040
  • Fax:
Mailing address:
  • Phone: 773-414-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704289403
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704289403
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: