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General NPI Number Information
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NPI Number | 1942208905
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Entity Type | Individual
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Provider Name | PRAKASH S BHOOPALAM M.D
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 2525 W UNIVERSITY AVE SUITE 404
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City | MUNCIE
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State | IN
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Zip | 47303
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Country | US
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Telephone | 765-231-9494
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Fax | 765-587-4456
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Provider Business Mailing Address
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Address Line | 10520 ROXLEY BEND
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City | CARMEL
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State | IN
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Zip | 46032
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Country | US
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Telephone | 765-729-5829
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 01040631A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01040631A
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License Number State | IN
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