Healthcare Provider Details

I. General information

NPI: 1376667337
Provider Name (Legal Business Name): ANIL S PRASAD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 TELEGRAPH RD SUITE #101
TAYLOR MI
48180-3375
US

IV. Provider business mailing address

5659 BREEZE BAY DR
SYLVANIA OH
43560-8986
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-7200
  • Fax: 313-295-0009
Mailing address:
  • Phone: 419-882-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301087082
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: