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General NPI Number Information
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NPI Number | 1114335049
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Entity Type | Individual
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Provider Name | PRATHAP BANDIPALLIAM MD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 2688 PINK PIGEON PKWY 225
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City | LEXINGTON
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State | KY
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Zip | 40509-2258
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Country | US
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Telephone | 646-884-2611
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Fax |
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Provider Business Mailing Address
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Address Line | 2688 PINK PIGEON PKWY #225,
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City | LEXINGTON
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State | KY
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Zip | 40509-2258
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Country | US
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Telephone | 646-884-2611
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 43267
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 40576
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301067795
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License Number State | MI
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