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1477556868

NPI Code Detail

MEDICARE: DR. PRABHAKAR P. KESAVA MD

MEDICARE: DR. PRABHAKAR P. KESAVA 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	2085R0202X	Diagnostic Radiology Physician	K4102	TX
2	2085R0202X	Diagnostic Radiology Physician	MD00040798	WA
3	2085N0700X	Neuroradiology Physician	MD00040798	WA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477556868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRABHAKAR P. KESAVA MD

Provider Business Mailing Address
First Line	:	19020 33RD AVE W STE 210
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-4748
Country	:	US
Telephone Number	:	425-563-1500
Fax Number	:	425-563-1374

Provider Business Practice Location Address
First Line	:	19020 33RD AVE W STE 210
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-4748
Country	:	US
Telephone Number	:	425-563-1500
Fax Number	:	425-563-1501

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/21/2022

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1669411187 — DR. ANDREW W BAUER MD
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1639179096 — DR. CAMELIA G WHITTEN MD
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1255333886 — DR. JONATHAN PAUL NAATZ MD
Practice Location Address:

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1417942269 — DR. JAMES E. BELL I MD
Practice Location Address:

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1497741870 — DR. RANDI WAYNE HART MD
Practice Location Address:

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Directions to “ DR. PRABHAKAR P. KESAVA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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