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General NPI Number Information
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NPI Number | 1700032182
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Entity Type | Organization
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Legal Business Name | KUSUM R PRABHAKAR MD PC
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Dates
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Enumeration Date | 08/17/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 1336 WYOMING BLVD NE SUITE F
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-5066
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Country | US
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Telephone | 505-275-2442
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Fax | 505-275-2443
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Provider Business Mailing Address
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Address Line | PO BOX 65605
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City | ALBUQUERQUE
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State | NM
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Zip | 87193-5605
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Country | US
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Telephone | 505-275-2442
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Fax | 505-275-2443
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KUSUM R PRABHAKAR
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Credential | M.D
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Telephone | 505-275-2442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 77234
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License Number State | NM
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