Healthcare Provider Details

I. General information

NPI: 1437314408
Provider Name (Legal Business Name): NAVIN PRASAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12745 S SAGINAW ST #806-196
GRAND BLANC MI
48439-2437
US

IV. Provider business mailing address

44201 DEQUINDRE RD
TROY MI
48085-1117
US

V. Phone/Fax

Practice location:
  • Phone: 248-691-8646
  • Fax:
Mailing address:
  • Phone: 248-691-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301090262
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: