MEDICARE: DR. PRAVEEN CHANDRA PRASAD MD

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	208600000X	Surgery Physician	30165	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164429403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRAVEEN CHANDRA PRASAD MD

Provider Business Mailing Address
First Line	:	1000 73RD ST STE 17
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-1321
Country	:	US
Telephone Number	:	515-223-2383
Fax Number	:	515-225-8679

Provider Business Practice Location Address
First Line	:	1000 73RD ST STE 17
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-1321
Country	:	US
Telephone Number	:	515-223-2383
Fax Number	:	515-225-8679

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	06/04/2024

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