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General NPI Number Information
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NPI Number | 1710483698
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Entity Type | Individual
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Provider Name | MISS PREEYA PRAKASH
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Gender | Female
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Dates
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Enumeration Date | 04/01/2018
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 4201 SAINT ANTOINE ST # 9C
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-5147
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Fax |
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Provider Business Mailing Address
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Address Line | 51 E WILLIS ST APT 4
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City | DETROIT
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State | MI
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Zip | 48201-1842
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Country | US
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Telephone | 801-808-6010
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | DR.0073992
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License Number State | CO
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