Healthcare Provider Details

I. General information

NPI: 1427045392
Provider Name (Legal Business Name): PRAKASH TAUJALE SHRESTHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MAIN ST
DOWAGIAC MI
49047-1762
US

IV. Provider business mailing address

520 MAIN ST
DOWAGIAC MI
49047-1762
US

V. Phone/Fax

Practice location:
  • Phone: 269-390-0536
  • Fax:
Mailing address:
  • Phone: 269-390-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5253
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301110156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: