Healthcare Provider Details

I. General information

NPI: 1679675748
Provider Name (Legal Business Name): PRASAD BALKRISHNA BICHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

IV. Provider business mailing address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

V. Phone/Fax

Practice location:
  • Phone: 724-773-1941
  • Fax: 724-773-8370
Mailing address:
  • Phone: 724-773-1941
  • Fax: 724-773-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD454185
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2010015537
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number2010015537
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: