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General NPI Number Information
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NPI Number | 1457409971
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Entity Type | Organization
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Legal Business Name | SHIVANA N. PRAKASH MDPC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 43311 COMMONS DR
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City | CLINTON TWP
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State | MI
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Zip | 48038-1109
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Country | US
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Telephone | 586-263-8555
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Fax | 586-263-8558
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Provider Business Mailing Address
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Address Line | 43311 COMMONS DR
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City | CLINTON TWP
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State | MI
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Zip | 48038-1109
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Country | US
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Telephone | 586-263-8555
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Fax | 586-263-8558
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | SHIVANA N PRAKASH
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Credential | MD
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Telephone | 586-263-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | SP407447
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License Number State | MI
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