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General NPI Number Information
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NPI Number | 1679506885
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Entity Type | Organization
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Legal Business Name | PRASAD.A.IRAGAVARAPU, M.D, P.A
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 6670 NEWPORT LAKE CIR
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City | BOCA RATON
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State | FL
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Zip | 33496-3001
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Country | US
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Telephone | 561-997-8531
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Fax |
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Provider Business Mailing Address
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Address Line | 6670 NEWPORT LAKE CIR
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City | BOCA RATON
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State | FL
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Zip | 33496-3001
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Country | US
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Telephone | 561-997-8531
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRASAD ACHYUTA IRAGAVARAPU
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Credential | M.D
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Telephone | 561-997-8531
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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 | 0039794
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License Number State | FL
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