Healthcare Provider Details

I. General information

NPI: 1013443274
Provider Name (Legal Business Name): RAHUL PRAKASH, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 GREENHOUSE RD SUITE 15
HOUSTON TX
77084-7287
US

IV. Provider business mailing address

3001 PALM HARBOR BLVD SUITE A
PALM HARBOR FL
34683-1930
US

V. Phone/Fax

Practice location:
  • Phone: 713-464-9100
  • Fax:
Mailing address:
  • Phone: 727-474-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDY VERMON
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-464-9100