Healthcare Provider Details

I. General information

NPI: 1619931276
Provider Name (Legal Business Name): ARAKERE BANDIGOWDA PRASAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 EST LA GRANDE PRINCESS SUITE 1
CHRISTIANSTED VI
00820-5165
US

IV. Provider business mailing address

4040 EST LA GRANDE PRINCESS SUITE 1
CHRISTIANSTED VI
00820-5165
US

V. Phone/Fax

Practice location:
  • Phone: 340-718-7788
  • Fax:
Mailing address:
  • Phone: 340-718-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number621
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: