MEDICARE: MANISH 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	2084P0800X	Psychiatry Physician	4301079202	MI
2	2084P0805X	Geriatric Psychiatry Physician	4301079202	MI

General Provider Information

NPI Number	:	1558395947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANISH PRASAD M.D.

Provider Business Mailing Address
First Line	:	4151 LAKE FOREST CT
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-2769
Country	:	US
Telephone Number	:	517-263-8905
Fax Number	:	517-265-0829

Provider Business Practice Location Address
First Line	:	1040 S WINTER ST
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-3876
Country	:	US
Telephone Number	:	517-263-8905
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	02/20/2024

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Directions to “ MANISH PRASAD M.D.” Practice Location

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