MEDICARE: KEERTHI D PRASAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician	01074777B	IN
2	2085R0204X	Vascular & Interventional Radiology Physician	D0102278	MD
3	2085R0204X	Vascular & Interventional Radiology Physician	T8019	TX
4	2085R0202X	Diagnostic Radiology Physician	0107477A	IN
5	2085R0202X	Diagnostic Radiology Physician	T8019	TX
6	2085R0204X	Vascular & Interventional Radiology Physician	01074777A	IN

General Provider Information

NPI Number	:	1043518186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEERTHI D PRASAD M.D.

Provider Business Mailing Address
First Line	:	5801 POSTAL RD UNIT 81310
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44181-2112
Country	:	US
Telephone Number	:	301-340-8339
Fax Number	:

Provider Business Practice Location Address
First Line	:	8611 HILLCREST AVE STE 200B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-4203
Country	:	US
Telephone Number	:	469-399-5672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2011
Last Update Date	:	05/07/2026

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