Healthcare Provider Details

I. General information

NPI: 1538156633
Provider Name (Legal Business Name): RACHAKONDA D PRABHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: R D PRABHU MD

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W. CHARLESTON BLVD. SUITE100
LAS VEGAS NV
89146
US

IV. Provider business mailing address

5701 W. CHARLESTON BLVD. SUITE100
LAS VEGAS NV
89146
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-9514
  • Fax: 702-312-3510
Mailing address:
  • Phone: 702-877-9514
  • Fax: 702-312-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number3775
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3775
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number3775
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number3775
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: