Healthcare Provider Details

I. General information

NPI: 1588806277
Provider Name (Legal Business Name): PRASANTH PILLAI D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE M-005
KALAMAZOO MI
49007-5381
US

IV. Provider business mailing address

601 JOHN ST SUITE M-005
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-6350
  • Fax: 269-341-8580
Mailing address:
  • Phone: 269-341-6350
  • Fax: 269-341-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number5101020186
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: